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Background and Aims Central neuraxial blocks are a relatively safe procedure with the risk of major complications being relatively rare. Hence, it is usually the preferred anaesthesia technique for lower segment Caesarean section (LSCS) surgery. However major complications can include cardiovascular collapse, complete neuraxial block, vertebral canal haematoma, nerve injury and meningitis.

Methods A 33 year-old Chinese lady presented for elective caesarian section at a gestational age of 39+3 weeks. She had no known drug allergies and no significant past medical history apart from a body mass index of 36 kg/m2 (93kg, 161cm). Ultrasound-assisted spinal anaesthesia was performed at the L4/5 interspace with a 27-gauge pencil point spinal needle. 2.4ml of 0.5% heavy bupivacaine, 15mcg of fentanyl and 0.1mg of morphine (in a total of 2.8ml) was administered. A block height of T4 was established within 10 minutes, surgery was commenced and a healthy baby was delivered uneventfully.

Results Twelve minutes after delivery, the patient started to desaturate and subsequently became unresponsive. Her airway was secured with endotracheal intubation and her ventilation and haemodynamics remained stable. Investigations including a CT brain were unremarkable and she subsequently regained consciousness and made a full recovery. We postulate that her presentation was possibly due to a subdural block given the delayed and atypical presentation.

Conclusions While subdural blocks are a rare complication of central neuraxial blocks, it is important to consider this differential in patients presenting with atypical symptoms following a central neuraxial block.