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VOLUME 9 , ISSUE 1 ( January-June, 2024 ) > List of Articles

CASE REPORT

Severed Epidural Catheter: An Anesthesiologist's Dilemma

Balaji Sridharan, Minal Harde, Sona Dave, Varsha Suryavanshi

Keywords : Anesthesia, Case report, Epidural catheter, Severed, Surgery

Citation Information : Sridharan B, Harde M, Dave S, Suryavanshi V. Severed Epidural Catheter: An Anesthesiologist's Dilemma. Res Inno Anesth 2024; 9 (1):14-17.

DOI: 10.5005/jp-journals-10049-2047

License: CC BY-NC 4.0

Published Online: 26-07-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aim and background: Breakage of the epidural catheter remains an infrequent complication of a commonly performed anesthetic procedure and poses a dilemma for management. Visualization of the retained epidural catheter is aided by radiological imaging techniques, and active surgical intervention may be necessary. Case description: A 41-year-old male underwent emergency implant removal under epidural and spinal anesthesia. Epidural insertion was done on the third attempt using an 18G Tuohy needle in L3/L4 interspace after multiple bony contacts, and epidural catheter was fixed at 10 cm at the skin, followed by spinal at L4/L5 interspace using a 25G Quincke spinal needle. Epidural was successfully used intraoperatively. On attempting to remove the catheter postsurgery with gentle traction, it was found to be sheared off at the 8 cm mark. Magnetic resonance imaging of the spine in coronal and sagittal reconstruction was done, which showed catheter at L3/L4 posterior epidural space and superior endplate of L3. After multidisciplinary discussion and as per the patient's wishes, as there was a retained long segment (8 cm) of catheter near the nerve root, successful surgical removal under general anesthesia was done. Conclusion: A combination of patient and technical factors can lead to shearing of epidural catheter, and it is important to follow conventional guiding principles for insertion and removal. Despite the above measures, if such a complication arises, intimating the surgeons and explaining to the patient and relatives is of utmost importance. Appropriate radiological evaluation is mandatory, and surgical intervention may be necessary to remove the catheter. Clinical significance: A severed epidural catheter can be troublesome to anesthesiologist and patient due to the possibility of neurological complications. Radiological evaluation may be difficult though it is radiopaque. It may remain inert in epidural space or may need multidisciplinary approach for its removal if a complication arises.


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