Knotting of a Cervical Epidural Catheter in the Patient with Post-Herpetic Neuralgia: A Rare Complication

Abstract

Epidural block is achieved either by single injection of local anesthetic through an epidural needle or as a continuous block by infusion pump through an epidural catheter. Complications associated with epidural catheters include breakage, entrapment, and knotting. Knotting of epidural catheters is very rare, but knotting in lumbar epidural catheters has been reported in a number of studies, and most of these cases involved removal difficulty. We report a case in which we inserted a cervical epidural catheter in a patient who was experiencing severe post-herpetic neuralgia and then removed the knotted catheter without complications.

Accidental knotting and subsequent removal of a catheter from the epidural space in an adult cow: a case report

“…The authors were aware of these options at the time of removal and propose this as a feasible approach to entrapped catheters in any species. Typically, gentle traction is sufficient for catheter removal, with 69% (11/16) of knotted catheters removed by this method [8][9][10][11][12][13][14][15][16][17][18][19][25][26][27]. In the current report, when resistance to traction was encountered, the initial concern was whether the catheter had entrapped a nerve root.…”

“…The low incidence of knotting makes investigation of contributing factors difficult. Insertion depth into the epidural space is commonly perceived as a risk factor for knot formation [8][9][10][11][12][13][14][15][16][17]; however, evidence is anecdotal, based on an assumed correlation between insertion depth and knot development. Knots have been described in people with catheter insertion as little as 2-3 cm into the epidural space [18,19], and prospective human studies evaluating catheter insertion depth of between 2 and 7 cm did not identify an association between insertion depth and knotting [20,21].…”

“…Renehan et al and others [] proposed a stepwise approach to the removal of an entrapped epidural catheter in people; (1) apply continuous gentle traction with the patient in various positions, (2) attempt to flush the catheter to determine patency (a knotted catheter is unlikely to be patent), (3) perform diagnostic imaging with the use of a guide or contrast injection to determine the position and patency of the catheter, and finally (4) explore the feasibility of surgical excision. The authors were aware of these options at the time of removal and propose this as a feasible approach to entrapped catheters in any species.…”

Management of an Entrapped Epidural Catheter

“…Epidural anesthesia is a highly effective and well-tolerated technique for pain management after abdominal surgery [ 1 ]. Complications related to epidural catheter insertion are rare and may include catheter breakage, entrapment, and knotting [ 1 ].…”

“…Epidural anesthesia is a highly effective and well-tolerated technique for pain management after abdominal surgery [ 1 ]. Complications related to epidural catheter insertion are rare and may include catheter breakage, entrapment, and knotting [ 1 ]. Various techniques have been described for safe removal of the catheter, including change of patient position, slow traction, continued traction over time, and injection of saline [ 2 ].…”