Two blood patches have failed. Now what?

Abstract

I was not thrilled when the newest patient requested an epidural at the end of my shift on the obstetrics floor. To put it nicely, her anatomy promised it would be a technically challenging procedure-there were no palpable landmarks to speak of on her back. After my Tuohy needle hit bone for a fifth time, I called the supervising anesthesiologist covering obstetric anesthesia that day to provide assistance and moral support. He struggled for several minutes before his needle seemed to find a promising spot. And as he advanced the needle a touch more, his persistence was rewarded with a steady stream of cerebrospinal fluid. A "wet tap"-the attending and I stared at each other. He quickly removed the epidural catheter from the tray and threaded it through the needle into the intrathecal space.