A Retained Epidural Catheter Fragment Treated by Surgery

Abstract

The breakage of an epidural catheter is an extremely rare complication. We describe a unique case where a retained epidural catheter fragment after epidural anesthesia was treated by surgery. The epidural catheter broke during its removal, requiring surgery to remove the retained catheter. Intraoperatively, the removal of the catheter was attempted by simple traction, but was impossible because of the adhesion. The adhesion of the dura mater surface was carefully exfoliated and the successful removal of the catheter was accomplished. Conventionally, it was said that this follow-up was enough for the retained catheter. However, if a catheter is retained within the spinal canal, surgical removal should thus be considered before the adhesion advances.

Percutaneous fully endoscopic surgical management of the ruptured epidural catheter: Rescue of the young anesthesiologist from his dilemma

“…When the patient shows symptoms of nerve compression or irritation or a foreign body stress response, it is too late to consider surgical treatment, as the di culty and risk of surgery are signi cantly increased; thus, it is recommended to remove the residual catheter as soon as possible [7,8]. Early routine surgery requires removal of the lamina, spinous processes, and articular processes of the corresponding segment to remove the broken catheter, which destroys the stability of the spine and requires the assistance of the pedicle screw rod system to maintain spinal stability [9,15]. Therefore, conventional surgery is traumatic and expensive, involves heavy bleeding, and results in slow postoperative recovery and obvious pain in the operation area [14,15].…”

“…Early routine surgery requires removal of the lamina, spinous processes, and articular processes of the corresponding segment to remove the broken catheter, which destroys the stability of the spine and requires the assistance of the pedicle screw rod system to maintain spinal stability [9,15]. Therefore, conventional surgery is traumatic and expensive, involves heavy bleeding, and results in slow postoperative recovery and obvious pain in the operation area [14,15]. These factors will inevitably lead to complaints from the patients and their families, who may resort to law and initiate a medical dispute [16].…”

Retained Paravertebral Catheter Fragment during Removal. A Rare Event without Damage for the Patient

“…1,2 Complications such as breakage of the catheter have been described with the epidural technique but are very rare in the case of paravertebral blocks. [3][4][5][6] A 62-year-old female patient underwent a right lower lobectomy through a videothoracoscopic posterior approach with a conversion to a posterolateral muscle-sparing thoracotomy with rib spreading as a result of technical difficulties. At the end of the surgery, the operating surgeon inserted a paravertebral catheter under direct vision.…”

“…6 There is no consensus regarding the management of retained epidural catheters into the spinal canal. 4,5 Tarukado et al suggest that small pieces could not be retrieved; on the contrary, when the retained piece causes clinical symptoms or signs, surgical retrieval through a laminectomy is warranted. 5 The same principle could be applicable for retained paravertebral catheters after thoracic surgery.…”

“…4,5 Tarukado et al suggest that small pieces could not be retrieved; on the contrary, when the retained piece causes clinical symptoms or signs, surgical retrieval through a laminectomy is warranted. 5 The same principle could be applicable for retained paravertebral catheters after thoracic surgery. In our opinion, small parts like the case reported herein, can be left in place, provided that there is no associated symptom.…”