u/minordetour

(ST3 resident here, in UK)

A situation I encounter fairly frequently in obstetrics and never got a straight answer for.

Doing a spinal, as you feel the spinal needle pass through dura and you get a loss of resistance feeling, the patient reports a fleeting paraesthesia down one leg. You remove the stylet and you see clear CSF flowing freely.

What should you do in this situation? Withdraw and reinsert/withdraw and redirect the spinal needle, aiming away from the side you got paraesthesia on? Or, seeing clear CSF flowing freely, assume you’re safely intrathecal, and inject your spinal dose? Why/why not?

Does the calculus change if it was a difficult spinal that required a few attempts?

Does paraesthesia always indicate you’re off midline?

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