Peculiar patient reported epidural story - thoughts welcome.

Hey everyone!

I had a patient a couple weeks ago describe a rather peculiar experience she had had with a prior epidural and I wasn't 100% sure what to make of it. Basically she described an easy placement, but she reports that she only ever got numb up to around T12 or L1. The block was symmetrical. She reports that she continued to have a lot of abdominal pain with contractions but hardly any with delivery itself. She said that the anesthesia team had tried a bunch of high volume boluses but the level of her block never got any higher. She did get exceptionally numb in her legs and was unable to walk after delivery for about 18 hours.

So, I am curious if anyone has a possible explanation.

The only things I could think of is that she potentially had something blocking upward flow of the local such as spinal stenosis, a bulging disk, or something. Alternatively, I figured they might have had the tuohy upside down and threaded the catheter downward/caudal. If they had, I would still assume that a high enough volume bolus would flow upwards to a low thoracic, but I am not entirely familiar with the implications of a caudal directed lumbar epidural.