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Background and Aims Total spinal block, characterized by extensive sensory and motor blockade beyond the intended spinal level, is an uncommon but a serious complication of neuraxial anesthesia. The mechanisms underlying this phenomenon, particularly with combined spinal-epidural techniques, remain unknown.

Methods We present the case of a 32-year-old woman, admitted for labor induction at 41 weeks gestation. Combined spinal-epidural anesthesia was performed for labor analgesia. An unintended dural puncture with the Tuohy needle was identified, with the epidural catheter inserted at a lower level. Using a combined technique, an intrathecal dose of sufentanil and ropivacaine was administered, followed by the uneventful administration of 3mL lidocaine 2% through the epidural catheter. Epidural analgesia was maintained with protocol of ropivacaine/sufentanil bolus, administered by nurses upon patient request.

Results Nine hours later, cesarean was performed due to fetal hypoxia. Lidocaine 2%, ropivacaine 0.75%, and sufentanil were administered via the epidural catheter. Paresthesias were reported, followed by respiratory arrest, with no signs of hemodynamic instability. Emergency tracheal intubation and cesarean delivery were performed, with no consequences for the newborn. The patient was transferred to the ICU, where motor block regression occurred approximately 5 hours later with successful extubation.

Conclusions The occurrence of total spinal block in this case prompts hypotheses such as epidural catheter migration into the intradural space or local anesthetic migration through the dural puncture site. This rare occurrence emphasizes the importance of preventive protocols during dural puncture. Further research is needed to understand the mechanisms and risk factors for total spinal block in combined spinal-epidural anesthesia.