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Background and Aims Epidural analgesia is commonly used during labor for pain management, but it carries the risk of complications such as catheter migration, resulting in high or total spinal anesthesia. We present a case of previously functioning epidural catheter migration during labor, leading to high spinal anesthesia.

Methods A 29-year-old woman was admitted for labor induction, during which an epidural catheter was inserted for pain management. Following a negative aspiration test for blood or cerebrospinal fluid, the epidural catheter was secured, tested, and a total of 10mL 0.2% ropivacaine with sufentanil was administered, providing pain relief. About an hour later, due to new pain complaints, a 10mL bolus of 0.2% ropivacaine was administered after a negative aspiration test for cerebrospinal fluid.

Results Shortly afterward, maternal hypotension and lower and upper limb paresthesias developed, prompting intervention by the medical team. The patient was transferred to the OR, and emergency drugs and equipment were prepared. After continuous monitoring, a decision was made to perform a cesarean section due to fetal instability. Due to insufficient blockade and after discussion with the patient, the catheter was removed, and a new epidural catheter was replaced. The cesarean section was performed under epidural anesthesia. The patient was discharged from the delivery room two hours post-delivery and about 12h later, she developed a positional headache, managed with medication and bed rest.

Conclusions The exact position of the catheter remained uncertain, but intrathecal or subdural migration was suspected, emphasizing the importance of early detection and proper training to manage such complications effectively.