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Background and Aims A 26-year-old ASA 2 primiparous lady experienced motor and sensory block for more than 72 hours following uncomplicated spinal anaesthetic injection for elective Caesarean delivery. She had a BMI of 29.7 and multi-level disc herniation with episodic sciatica and previous steroid epidural injections.

Methods Spinal anaesthetic was performed by an experienced operator without any immediate complications.

Results At 7 hours following the spinal injection, she continued to experience complete motor block of lower limbs and reduced sensation up to her hips. At this point she mentioned similar prolongation of block with epidural injections for pain on two previous occasions. MRI was performed at 25 hours due to unavailability overnight. The report ruled out an epidural haematoma. Neurology referral recommended conservative management. She started mobilising at 75 hours and was discharged home. On follow up she was asymptomatic.

Conclusions Patient factors, such as low CSF volume [1], peak diastolic CSF velocity [2], and genetic predispositions [3] have all been linked to excessive block duration and may be unknown at the time of the procedure. In patients with pre-existing spinal stenosis, epidural injection may precipitate radiculopathy due to changes in local blood circulation [4], and patients suffering from demyelinating diseases may require lower doses of local anaesthetic, due to increased sensitivity of demyelinated neurons to the drug [5,6]. Understanding of causation is vital to establish whether procedures could be safely repeated in the future.