Article Notes
Far from earth-shattering, though what I find (possibly) interesting is the long delay between the last epidural dose and the (apparent) total spinal.
90 min seems like it should be well and truly long enough for any epidural bupivacaine to be absorbed – in fact, this is probably only a little shorter than the duration of said dose. It's possible that the total spinal was totally unrelated to the epidural, but that's probably wishful thinking.
Previous studies (Dadarkar, IJOA 2014) have suggested that waiting 30 min between last epidural dose and spinal is safe (audit of 115 patients in Dallas).
The take-away for me is that there's probably more patient variability than we'd like to admit.
Crash risk and trauma severity are directly related to vehicle speed and posted speed limit.