Cateter epidural

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Indian Journal of Anaesthesia 2007; 51 (5) : 434-437

Case Report
Indian Journal of Anaesthesia, October 2007

Epidural Catheter Breakage:A Dilemma
Deepanjali Pant1, Pradeep Jain 2, Pravesh Kanthed3 , Jayashree Sood4
Summary
Placement of an epidural catheter in epidural space is a routine practice for providing anaesthesia/analgesia in a myriad of
surgical procedures and various painfulconditions. Breakage of an epidural catheter, though rare, is a well-known complication.
We present a case report of such an event and a comprehensive review of do’s and don’ts in this setting.

Key words

Epidural catheter, Breakage, Management.

Introduction
A broken spinal or epidural catheter, although an
uncommon occurrence, remains an area of utmost dilemma to the practisinganaesthesiologist. While the insertion of a spinal or epidural catheter is usually safe,
they have been known to break during removal, leaving
a segment lodged in patient’s back.1 Since surgical removal of a broken catheter is not recommended and the
severed nonbiodegradable catheter is situated in an anatomical region which does not permit it to be naturally
extruded, it is left in the patientpermanently. 2 The discomfort to the patient and the formidable complication
that may rarely result from such a mishap could greatly
deter surgeons, anaesthesiologists and patients from this
most useful anaesthetic technique. .

relocate the epidural space. While the catheter was being removed with gentle traction along with Tuohy needle,
it sheared off at 6 cm mark. (Fig.1)

Case report
A 70-yr - old, 65 kg male, presented with history
of road traffic accident leading to multiple rib fractures
on right side. He was a known case of COPD, on intermittent bronchodilator therapy. Due to severe pain related to rib fracture, the patient was unable to cough out
secretions effectively. He was referred to acute pain
services for pain relief.

Fi g.1 Epidural catheter-broken at 6 cmmark.

A new epidural catheter was placed at the T 11-T 12
interspace and fixed at 9 cm mark (skin to epidural distance = 5 cm). Patient controlled epidural analgesia
(PCEA) was initiated with a combination of 0.0625%
bupivacaine hydrochloride and fentanyl citrate (5 g.ml
1
). The patient had adequate pain relief and chest condition improved satisfactorily. PCEA was used for 7 days
and theepidural catheter was removed uneventfully.
Subsequently the patient was discharged without any
neurological sequelae.

A thoracic epidural analgesia was planned and using the loss-of-resistance technique with air, an 18G radio opaque epidural catheter [Perifix® 401 G18x31/4”(B/
Braun)] was inserted through an 18G Tuohy needle into
the epidural space at T8-T9 interspace in left lateralposition. The epidural space was encountered at 5 cm from
skin and catheter was advanced cephalad upto 15 cm at
hub of the needle. Resistance was encountered while
injecting the test dose and therefore it was decided to

1.M.D, Consultant, 2.MD, Senior Consultant, 3.DA, DNB, Senior Resident, 4.MD, FFARCS, PGDHHM, Senior Consultant, Chairperson
Correspondence to: Deepanjali Pant, Department ofAnaesthesiology, Pain & Perioperative Medicine, Sir Ganga Ram Hospital, Sir Ganga
Ram Hospital Marg, New Delhi – 110060, India, Email: deepapant@hotmail.com
Accepted for publication on:30.8.07

434

Deepanjali Pant et al. Epidural catheter breakage
After informing the surgeon and the patient, an
MRI and CT scan were done. Sagittal 3-mm (with 1mm gap) and axial 5-mm (with 1.5-mm gap) T 1weighted spin-echo (TR 500 ms/TE 16 ms/ 2 excitation)
and proton density and T 2- weighted (TR 2600 ms/TE
16,96 ms/2 excitation) fast spin-echo images were obtained in a 1.5T MRI scanner (General electric signal)
(matrix 256x256, field of view 20 cm axial, 28 cm sagittal). Axial and sagittal T1 -weighted images after IV
gadolinium DTPA were obtained. CT scan (4-mm images obtained at 3-mm interval)...
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