CSE..the spinal didnt work

The incidence of failed spinal after CSE is 5% ..better than old reports of 25%.

5causes for failed spinal:

Smaller-gauge spinal needles with long lengths are typically used. These needles lead to slower return of CSF and a greater resistance to injection.

Because the epidural needle has penetrated the tissue planes, there is little to anchor the spinal needle in place. Although a Luer lock apparatus is available, it locks at a fixed needle length and can result in not reaching or traversing the dura.

Any deviation from midline can lead to missing the dura altogether.

If loss-of-resistance technique used saline, a false return of saline in the spinal needle rather than CSF can occur.it is recommended to use LOR with air .

Finally, patient positioning and duration between spinal injection and completion of epidural catheter placement can change the characteristics of the spinal block

Cook TM. Combined spinal-epidural techniques. Anaesthesia 2000;55:42–64.

Goobie SM, Montgomery CJ, Basu R, et al. Confirmation of direct epidural catheter placement using nerve stimulation in pediatric

anesthesia. Anesth Analg 2003;97: 984–988

Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology 2001;94: 888–906.

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