Impacted epidural catheter, a predicament worth a thought.

Document Type : Case report

Authors

Department of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India.

10.21608/asja.2024.255262.1037

Abstract

Background: Epidural catheter placement in epidural space is widely used for providing regional anaesthesia/analgesia for various surgical procedures. Among the known complications, breakage/retention of epidural fragments is even though extremely rare, a well-established entity. Even with the best radiological tests, visualization of the fragment is often difficult and might prompt a surgical intervention.
Case Presentation: In a patient in their 60s, an 18G radiopaque epidural catheter was inserted through an 18G Tuohy needle using a combined spinal-epidural set into the epidural space at L3-L4 interspace in the sitting position. Resistance was encountered and the catheter was removed with gentle traction along with the Tuohy needle, it was found to be sheared off at the 8 cm mark. The operating surgeon and the patient were informed and immediately an X-ray followed by a computed tomography (CT) scan was done. A part of the epidural catheter was visualized near the L1 lamina-spinous junction, which was removed by surgical intervention.
Conclusion: An impacted epidural fragment presents a quandary to the anesthesiologist and the surgeons. The best way to evade such a situation is to follow the traditional guiding principles for the insertion and removal of an epidural catheter. However, if such a situation arises - patients and surgeons should be informed. Surgical intervention may be indicated in symptomatic patients or to avoid future complications.

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