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Abstract

Epidural catheters that are commonly placed for anaesthesia or analgesia have a serious complication of migration. Besides intravascular local anaesthetic infusion which could lead to systemic toxicity, a subdural migration is often diagnosed late and presents with life-threatening outcomes noted either at post-mortem or requiring intensive care management. Albeit training and protocols for insertion, administering and management of epidurals have been established, not all complications can be mitigated. We present a case of an epidural catheter migration in a patient with timely detection and management without airway compromise with an analysis of the detection, diagnosis and management. Various methods for diagnosis have been described in the literature as we discuss the pros and cons of bedside and radiological investigations. A high index of suspicion and knowledge of potential problems in the management of patient with in-dwelling epidural catheters prove vital to avoid complications with catheter migration. Adequate training and availability of emergency contact details would expedite management in emergencies.location [1]. This could potentially be life-threatening from inadvertent administration of epidural drug dosages into the subdural space. We present a case report of a patient who had a timely detection of possible epidural catheter migration into the subdural space while on a local anaesthetic infusion. Case ReportA 77-year-old lady was admitted for an elective open abdominal hysterectomy and bilateral salpingo-oophorectomy and left radical nephrectomy for complex atypical hyperplasia of her endometrium and left kidney angiomyolipoma. Her other medical problems include hypertension, hypercholesterolaemia and gastro-oesophageal reflux disease. Her previous surgeries include a total knee replacement, tonsillectomy and excision to her breast cyst. Her body mass index was 34.1 kg/m 2 and pre-operative investigations were within acceptable limits for her surgery. Appropriate consent was taken for surgery, regional and general anaesthesia before arrival to theatre.An epidural was inserted pre-induction under aseptic conditions for post-operative analgesia in the sitting position under monitoring. A midline approach was used at T8/9 interspace with a standard 8 cm 16 G Tuohy needle, under local anesthesia (lignocaine 1%) in two attempts, guided by loss of resistance to saline and air respectively. The needle insertion depth was 7 cm with the catheter anchored at 10 cm at skin. A lignocaine 2% 3 ml epidural test dose was also given before starting the epidural infusion of bupivacaine 0.1% with 2 mcg/ ml fentanyl at 10 ml/h. Subsequently, a right internal CAse RepoRTCheck for updates