Early recognition and safe management of unintentional intrathecal placement of an epidural catheter during combined spinal-epidural labor analgesia: a case report in the context of the 2024 OAA guidelines.

BACKGROUND: Unintentional intrathecal catheter placement is a recognized complication of labor neuraxial analgesia. Although continuous spinal analgesia (CSA) may be used as a management option, prompt recognition, careful catheter management, and close monitoring are required to prevent complications such as severe spinal anesthesia.

CASE PRESENTATION: A 31-year-old primigravida underwent combined spinal-epidural analgesia for labor pain. Intrathecal catheter placement was diagnosed after a test dose was administered based on hypotension, motor weakness, sensory block, and glucose-positive aspirated fluid. The catheter was managed as CSA with fentanyl-based analgesia under strict monitoring. Although frequent breakthrough pain required rescue boluses, the vaginal delivery was achieved uneventfully. The patient developed a post-dural puncture headache that resolved after an epidural blood patch.

CONCLUSIONS: This case illustrates the importance of early recognition of inadvertent intrathecal catheter placement and demonstrates that safe labor analgesia can be achieved through conversion to CSA with careful catheter management and close monitoring.