Cranial nerve block after test dose through an epidural catheter in a pre-eclamptic parturient

A case of unintentional high spinal anaesthesia is reported, in a 40-year-old obese patient at 38 weeks gestation, complicated by pre-eclampsia. In spite of careful technique in placement of an epidural catheter, the test dose of 3 ml bupivacaine 0.5 per cent produced an unusual block which ascended to include sensory blockade of the fifth cranial nerve, but the motor components of the cervical and thoracic segments were spared. This case suggests that a smaller epidural test dose of bupivacaine might be appropriate, especially in an obese and pre-eclamptic parturient.