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(Int J Obstet Anesth. 2017;30:61–66)In this case report a healthy 34 year-old woman undergoing her second cesarean section received combined spinal epidural anesthesia for surgery using an 18-G Tuohy epidural needle and a 25-G spinal needle. The spinal injection consisted of 0.75% ropivacaine 1.8 mL. Upon removal of the spinal needle, the epidural needle was rotated 90 degrees cephalad and an epidural catheter was inserted 3 cm into the epidural space. A T6 bilateral sensory level was achieved. The surgery was uneventful; the mother was stable throughout and a healthy was child delivered.