Catéter epidural roto, una complicación poco frecuente / Broken epidural catheter, a rare complication

Resumen: Actualmente, la anestesia neuroaxial es preferida por sus múltiples ventajas con respecto al manejo del dolor. El procedimiento involucra la colocación de un catéter epidural en el espacio peridural, una complicación muy rara es la ruptura de éste. Se estima una incidencia de 0.002 a 0.004%. El presente trabajo reporta el caso de un paciente masculino de 77 años sometido a una resección transuretral de próstata, que presenta ruptura del catéter durante el retiro. La tomografía reportó la presencia del catéter a nivel subaracnoideo, sin presencia de síntomas en el paciente. Se egresó y a los seis meses de seguimiento no presentaba síntomas. Es de importancia comprender que siempre se debe notificar al paciente en caso de que esto suceda y después realizar estudios de imagen para su localización. Posteriormente se debe valorar la presencia de síntomas y, si existen, considerar una laminectomía para su retiro.

Abstract: Nowadays, neuraxial anesthesia is preferred due to its multiple advantages related to pain management. This procedure involves placing an epidural catheter within the epidural space, with rupture of the catheter being an uncommon complication. Its incidence is around 0.002 to 0.004%. The present work reports the case of a 77-year-old male who underwent a transurethral prostate resection, where the catheter broke while being removed. CT scan reported the presence of the catheter within subarachnoid space, without the patient presenting symptoms. It is important to understand that notifying the patient is a priority in case this complication happens, and then order imaging studies to locate the catheter. Finally, if symptoms are present, a laminectomy should be assessed to remove the remaining piece.

Parotid duct anastomosis with an epidural catheter as a stent and evaluation of postoperative gland function / 口腔疾病防治

Objective @#To investigate the feasibility of epidural catheters in parotid gland duct anastomosis and the function of the affected side gland after parotid gland duct anastomosis. @* Methods@# Thirteen patients who were treated in the Department of Oral and Maxillofacial Surgery of Xuzhou Central Hospital using an epidural catheter as the scaffold for parotid gland catheter anastomosis were enrolled from Jan. 2019 to June 2021. The swelling, salivary fistula and catheter patency in the parotid gland area were evaluated two weeks after the operation. 99mTcO4- single photon emission computed tomography (SPECT) was used for quantitative detection of salivary gland secretion function@*Results@# Thirteen patients had no swelling or salivary fistula in the parotid gland area of the affected side two weeks after the operation, and the catheter secretion was unobstructed. There was no significant difference in the uptake rate between the parotid gland on the affected side and the parotid gland on the healthy side (t = -0.859, P = 0.399), and there was no significant difference in the excretion rate between the parotid gland on the affected side and the parotid gland on the healthy side (t = 0.693, P = 0.495). The parotid gland excretion function of the affected side was excellent three months after the operation.@*Conclusion @#Parotid duct anastomosis with an epidural catheter as the stent has good feasibility, and parotid gland secretion function recovers well after the operation, which is worthy of clinical application.

Catéter epidural seccionado: reporte de un caso y revisión de literatura / Sectioned epidural catheter: a case report and review of literature / Ruptura de cateter epidural: relato de caso e revisão da literatura

Resumen: La ruptura y retención de un fragmento de catéter peridural es una complicación poco frecuente de la analgesia epidural. Si bien generalmente requiere una conducta expectante con evolución sin mayores complicaciones, su importancia está dada por la escasa evidencia en cuanto al manejo, teniendo en cuenta que puede derivar en una intervención neuroquirúrgica, con sus riesgos y complicaciones. Exponemos el caso de una paciente que tuvo como complicación la ruptura y retención de un fragmento de catéter peridural durante la colocación del mismo para analgesia del parto.

Summary: Rupture and retention of an epidural catheter fragment is a rare complication of epidural analgesia. Although it generally requires expectant management and evolves without major complications, the event is important given the lack of evidence regarding treatment and considering it can lead to a neurosurgical intervention, what involves risks and complications. The study describes the case of a patient whose complication was the rupture and retention of a fragment of an epidural catheter during labor analgesia.

Resumo: A ruptura e retenção de um fragmento de cateter epidural é uma complicação rara da analgesia epidural. Embora geralmente exija uma gestão expectante com evolução sem grandes complicações, a importância é dada pela escassa evidência relativa ao manejo, considerando que pode levar à uma intervenção neurocirúrgica, com os correspondentes riscos e complicações. Apresentamos o caso de uma paciente cuja complicação foi a ruptura e retenção de um fragmento de cateter epidural durante sua colocação para analgesia do parto.

Sección de catéter epidural durante técnica anestésica espinal epidural combinada / Epidural catheter section during combined epidural spinal anesthetic technique

Estos son empleados con seguridad desde hace varias décadas; sin embargo, algunas complicaciones suelen presentarse. Una poco frecuente es su sección, la cual de no ser manejada adecuadamente genera importante morbilidad. Se presenta el caso de una paciente que recibe anestesia espinal epidural combinada. La técnica empleada, tanto para la colocación del catéter como para su retiro, aparentemente, fue correcta; sin embargo, este sufre una sección al retirarlo. En las imágenes posteriores se evidenciaría que el catéter se situó, accidentalmente, en el espacio paravertebral. Se teoriza un mecanismo de ruptura aun no descrito en la bibliografía. Se publica con el objetivo de mostrar la necesidad de la individualización en el manejo de este accidente, ya sea expectante o quirúrgico según las condiciones clínicas de cada paciente(AU)

The use of epidural catheters is a fundamental pillar of anesthesia. These have been safely employed for several decades; however, some complications usually occur. A rare one is its section, which if not properly managed generates significant morbidity. It is presented the case of a patient receiving combined epidural spinal anesthesia. The technique used, both for the placement of the catheter and for its removal, was apparently correct; however, it suffered a section when removed. In the subsequent images it was evident that the catheter was accidentally placed in the paravertebral space. A mechanism of rupture not yet described in the literature is theorized. It is published with the aim of showing the need for individualization in the management of this accident, whether expectant or surgical according to the clinical conditions of each patient(AU)

Retrograde Intubation An Alternative Way For Endotracheal Intubation Using Epidural Catheter As A Guide – A Case Report

Patients having restricted mouth opening and limited movement of tempro-mandibular joint present as difficult airway scenario. Fibre-optic assistance is a gold standard technique for anticipated difficult intubation, but it’s availability and expertise still is a challenge at most of places worldwide especially in developing countries.The retrograde intubation technique can be an alternative and less invasive than other emergency surgical airway options for such cases. We present a case of difficult intubation, successfully managed with the help of retrograde intubation.

Nudo verdadero en catéter peridural. Reporte de un caso / True knot in peridural catheter. A case report

Resumen: La anestesia epidural es una técnica que se realiza a ciegas y que por ende no está exenta de complicaciones; entre ellas, una poco común es la formación de un nudo verdadero. Se discute el caso de una gestante, a la cual se colocó bloqueo epidural con formación de un nudo verdadero que fue extraído quirúrgicamente. Conclusión: Si un catéter epidural no puede ser retirado de manera fácil, se deben aplicar maniobras descritas para el retiro del mismo y se puede ayudar de estudios de imagen como TAC o IRM para saber la forma y posición del catéter y, si el catéter tiene comunicación con el exterior, se debe extraer quirúrgicamente.

Abstract: Epidural anesthesia is a technique that is performed blindly and therefore is not free of complications, among them, a rare complication is the formation of a true knot. We discuss the case of a pregnant woman in whom an epidural block with a true knot formation was placed, which was surgically removed. Conclusion: If an epidural catheter cannot be removed easily, maneuvers described for removal should be applied and imaging studies such as CT or MRI may be used to determine the shape and position of the catheter and whether the catheter has communication with the outside must be extracted surgically.

“Spray-as-you-go” medical technique for awake intubation using a combination of an epidural catheter and the OptiScope in a patient with Ludwig's angina: A case report

A 73-year-old woman presented to the emergency department with submandibular pain and swelling. The patient was diagnosed to have Ludwig's angina, and she was planned to undergo urgent incision and drainage under general anesthesia. However, her physical examination revealed severe diffuse swelling extending from the bilateral submandibular spaces to the submental space and further down to the neck. As our view was blocked by the patient's neck swelling, we did not perform a regional anesthesia of the airway or a transtracheal block. Several non-invasive alternatives were considered. The “spray-as-you-go” technique was chosen, and it was performed using the OptiScope®. However, the OptiScope did not have a working channel or syringe adaptor for the administration of the local anesthetic solution. To solve this problem, we combined the OptiScope with a 27-G tunneled epidural catheter (100 cm) for the administration of lidocaine and this combination made the awake intubation successful.

Evaluation of the cardiopulmonary and antinociceptive effects of bupivacaine administered epidurally at the first lumbar vertebra in awake dogs / Estudo dos efeitos cardiopulmonares e antinociceptivos da administração epidural de bupivacaína à altura da primeira vértebra lombar em cães acordados

The aim of this study was to evaluate the effect of epidural bupivacaine administration at the first lumbar vertebra on cardiopulmonary variables, arterial blood gases and anti-nociception. Sixteen healthy female dogs were randomly assigned into two groups based on bupivacaine dose: G1 group, 1mg kg-1 or G2 group, 2mg kg-1, diluted in the same final volume (1mL4kg-1). Cardiopulmonary variables were measured and arterial blood gas was collected (T0), it was repeated 10 minutes after intravenous administration of butorphanol 0.4mg kg -1 (T1). Anesthesia was induced with intravenous etomidate at 2mg kg-1 and the epidural catheter was introduced and placed at the first lumbar vertebra. Thirty minutes later, bupivacaine was administered epidurally. Cardiopulmonary measurements and arterial blood gas analysis were recorded at 10 minute intervals (T2 to T6). Evaluation of pre surgical anti-nociception was performed at 5 minute intervals for 30 minutes by clamping the hind limbs, anus, vulva, and tail with the dogs awake. Subsequently, ovariohysterectomy was performed and adequacy of surgical anti-nociception was evaluated at 5 time points. Parametric data were analyzed using the F test with a <0.05 significance. After bupivacaine administration, there were differences between groups just for bicarbonate means (HCO3-) on T6 (P=0.0198), with 18.7±1.3 and 20.4±0.8 for G1 and G2, respectively. After T1, before bupivacaine administration, both groups presented a slightly lower pH, base excess (BE), the end-tidal carbon dioxide tension (PECO2), and partial pressure of carbon dioxide (PaCO2), suggesting mild metabolic acidosis. G2 showed better antinociceptive effect both before and during surgery. It was possible to perform ovariohysterectomy in 87.5% of the G2 bitches and 25% of the G1 bitches. The two doses of bupivacaine evaluated do not cause important alterations in the studied parameters and the dose of 2mg kg-1 results in a better antinociceptive effect.(AU)

O objetivo deste estudo foi avaliar os efeitos da administração epidural de bupivacaína à altura da primeira vértebra lombar sobre variáveis cardiopulmonares, hemogasometria arterial e antinocicepção. Dezesseis cadelas foram separadas aleatoriamente em dois grupos que se diferenciaram pela dose de bupivacaína, 1mg/kg (G1) ou 2mg/kg (G2), diluídas no mesmo volume final (1mL/4kg). As variáveis cardiopulmonares e hemogasometria arterial foram coletadas antes (T0) e após 10 minutos da administração intravenosa de 0,4mg/kg de butorfanol (T1). A anestesia foi induzida com 2mg/kg de etomidato intravenoso para introdução do cateter epidural. Após 30 minutos, a bupivacaína foi administrada e, passados 10 minutos, nova coleta de parâmetros foi feita, sendo repetida a cada 10 minutos (T2 a T6). Após cinco minutos da administração de bupivacaína, iniciou-se a avaliação da antinocicepção pré-cirúrgica, repetida a cada cinco minutos durante 30 minutos. Então, iniciou-se a cirurgia de ovário-histerectomia, na qual se avaliou a antinocicepção transcirúrgica em cinco momentos. Os resultados paramétricos foram analisados pelo software SAS 9.4 (2010), utilizando-se o teste F com significância menor que 0,05. Houve diferença entre as médias dos grupos após administração de bupivacaína apenas para bicarbonato em T6 (P=0.0198), sendo 18,7±1,3 e 20,4±0,8 as médias do G1 e G2, respectivamente. Desde T1, os grupos apresentaram valores de pH, excesso de bases, pressão parcial de gás carbônico no sangue arterial e tensão de dióxido de carbono ao final da expiração pouco abaixo do fisiológico, sugerindo acidose metabólica discreta. O G2 apresentou efeito antinociceptivo pré e transcirúrgico superior ao G1. Foi possível realizar a cirurgia em 87,5% das cadelas do G2 e em 25% das cadelas do G1. Concluiu-se que as duas doses de bupivacaína avaliadas não acarretam alterações importantes nos parâmetros fisiológicos estudados e a dose de 2mg/kg determina melhor efeito antinociceptivo que a dose de 1mg/kg.(AU)

Accidental catheterization of epidural venous plexus: tomographic analysis / Cateterização acidental do plexo venoso peridural: análise tomográfica

ABSTRACT BACKGROUND AND OBJECTIVES: Inadvertent venous catheterizations occur in approximately 9% of lumbar epidural anesthetic procedures with catheter placement and, if not promptly recognized, can result in fatal consequences. The objective of this report is to describe a case of accidental catheterization of epidural venous plexus and its recording by computed tomography with contrast injection through the catheter. CASE REPORT: A female patient in her sixties, physical status II (ASA), underwent conventional cholecystectomy under balanced general anesthesia and an epidural with catheter for postoperative analgesia. During surgery, there was clinical suspicion of accidental catheterization of epidural venous plexus because of blood backflow through the catheter, confirmed by the administration of a test dose through the catheter. After the surgery, a CT scan was obtained after contrast injection through the catheter. Contrast was observed all the way from the skin to the azygos vein, passing through anterior and posterior epidural venous plexuses and intervertebral vein. CONCLUSION: It is possible to identify the actual placement of the epidural catheter, as well as to register an accidental catheterization of the epidural venous plexus, using computed tomography with contrast injection through the epidural catheter.

RESUMO JUSTIFICATIVA E OBJETIVOS: A cateterização venosa inadvertida ocorre em aproximadamente 9% das anestesias peridurais lombares com introdução de cateter e caso não seja prontamente reconhecida pode trazer consequências fatais. O objetivo deste relato é descrever um caso de cateterização acidental do plexo venoso peridural e o seu registro por tomografia computadorizada com injeção de contraste pelo cateter. RELATO DE CASO: Paciente feminina, sexagenária, estado físico II (ASA), submetida à colecistectomia convencional sob anestesia geral balanceada e peridural com cateter para analgesia pós-operatória. Durante cirurgia houve suspeição clínica de cateterização acidental do plexo venoso peridural, por refluxo de sangue pelo cateter, fato confirmado pela administração de dose-teste pelo cateter. Feita tomografia computadorizada com injeção de contraste pelo cateter, após o termino da cirurgia. Observado todo o trajeto do contraste desde a pele até a veia ázigo, passando pelo plexo venoso peridural anterior, posterior e veia intervertebral. CONCLUSÃO: É possível a identificação do real posicionamento do cateter peridural, bem como o registro da cateterização acidental do plexo venoso peridural, por meio de tomografia computadorizada com injeção de contraste pelo cateter peridural.

Application of wire-reinforced epidural catheter in combined spinal-epidural anesthesia for cesarean section / 中华全科医师杂志

Two hundred women with singleton pregnancy at full term undergoing cesarean section with combined spinal-epidural anesthesia were randomly assigned into 2 groups (n=100 in each group). During anesthesia the polyvinyl chloride epidural catheter was used in control group and the wire-reinforced epidural catheter was used in study group.The results showed that the number of patients in whom blood or blood-tinted fluid was withdrawn from epidural catheter was significantly lower in study group than that in control group.The domestic wire-reinforced epidural catheter can reduce the incidence of blood vessel injury induced by insertion of epidural catheter.

Optimize of the fiber optic epidural catheter and study of the epidural cavity surgical anatomical physiology / 局解手术学杂志

Objective To discuss the epidural cavity surgical anatomical physiology under fiber optic epidural catheter, and to analyze the technological advantages compared to the the agent under blind. Methods 60 cases who need to epidural abdominal surgery from Jan. to Nov. 2013 were collected. Common duct (30 cases) and fiber optical epidural catheter (30 cases) were respectively used at anesthesia, and the epidural cavity surgical anatomy physiology were observed. Results Compared with indexs before anesthesia, before induction and before intubation, the HR, SPB, and MAP in 5 min after intubation and at the moment of skin incision were of statistically significant differ-ences (P<0. 05). There is a cavity between epidural space and vertebral canal periosteum which is not linked to cranial cavity, but there were a certain amount of connective tissue and venous plexus. The volume of the cavity was about 100 mL, the front and side were narrow and the back was wide, and it began to gradually expand from the neck, and reached its peak at the waist, and then gradually narrowed, un-til the sacral hiatus. Conclusion Fiber optic epidural catheter could make the patient’ s anatomy physiology structure more clear, and it also make it possible to cathetering visually for the anesthesiologist.

Epidural Infusion of Morphine and Levobupivacaine through a Subcutaneous Port for Cancer Pain Management

BACKGROUND: To manage intractable cancer pain, an alternative to systemic analgesics is neuraxial analgesia. In long-term treatment, intrathecal administration could provide a more satisfactory pain relief with lower doses of analgesics and fewer side-effects than that of epidural administration. However, implantable drug delivery systems using intrathecal pumps in Korea are very expensive. Considering cost-effectiveness, we performed epidural analgesia as an alternative to intrathecal analgesia. METHODS: We retrospectively investigated the efficacy, side effects, and complications of epidural morphine and local anesthetic administration through epidural catheters connected to a subcutaneous injection port in 29 Korean terminal cancer patients. Patient demographic data, the duration of epidural administration, preoperative numerical pain rating scales (NRS), side effects and complications related to the epidural catheterization and the drugs, and the numerical pain rating scales on the 1st, 3rd, 7th and 30th postoperative days were determined from the medical records. RESULTS: The average score for the numerical pain rating scales for the 29 patients decreased from 7 +/- 1.0 at baseline to 3.6 +/- 1.4 on postoperative day 1 (P < 0.001). A similar decrease in pain intensity was maintained for 30 days (P < 0.001). Nausea and vomiting were the most frequently reported side effects of the epidural analgesia and two patients (6.9%) experienced paresthesia. CONCLUSIONS: Epidural morphine and local anesthetic infusion with a subcutaneous pump seems to have an acceptable risk-benefit ratio and allows a high degree of autonomy to patients with cancer pain.

Epidural catheterization in cardiac surgery: The 2012 risk assessment.

Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI) of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552). Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.

Epidural catheter elongated through subcutaneous tunnel from the puncture site to the frontal abdominal wall in terminally ill cancer patients: a report of 3 cases

Continuous epidural injection of opioid/local anesthetic drugs can be a useful tool to alleviate intractable pain in cancer patients. The use of an epidural catheter, however, always faces with contamination and infection. In order to avoid contamination, an injection port is often implanted in the subcutaneous space and intermittent or continuous injection is employed. The injection port requires an additional cost and a little more time for implantation. Both the cost and the time-requiring procedure may be of problem in the terminally ill cancer patients. We present 3 cases of cancer patients with high risk of catheter contamination treated with continuous epidural injection using catheters elongated through subcutaneous tunnel from the epidural puncture site to the front side of abdominal wall. The risk factors of the patients were; subcutaneous emphysema due to intestinal perforation in a 81 yr male with bladder cancer, local abscess and MRSA infection in a 45 yr female with uterine cancer, and cutaneous tissue disruption in a 51 yr female with lung cancer and multiple metastasis. The duration of epidural analgesia were 22, 26, and 21 days until the patient's death, respectively. Although the risk of epidural catheter contamination and infection was extremely high in all three patients, continuous epidural injection for more than 3 weeks was possible with favorable analgesic effects. Use of an epidural catheter elongated through subcutaneous route from the puncture site to the frontal abdominal wall offers a practical and inexpensive way in patients with intractable pain at least for a few weeks. Palliat Care Res 2011; 6(2): 350-357

Ultrasound-guided removal of epidural catheter breakage after percutaneous epidural neuroplasty: A case report

The breakage of epidural catheter seldom makes severe complication, but it may be a stressful event to nervous chronic pain patients. We discovered a retained epidural catheter in plain x-ray image and CT scan following a percutaneous epidural neuroplasty for a 62-year-old woman. Even though surgical removal of the catheter was not tried for 1 year, we decided to remove the catheter fragment as the patient's request, if exploration would be easy. Sonographic evaluation showed that the tip of the epidural catheter beneath subcunateous tissue between sacral hiatus. Ultrasound will be an invaluable tool when trying to remove the broken catheter under local anesthesia if its tip is out of the sacral hiatus.

Intercostal misplacement of a thoracic epidural catheter: A case report / 대한마취과학회지

Epidural block is useful for chronic pain and thoracic surgery. However, there are several complications, which include vessels or dural puncture, pleural puncture, misplacement of epidural catheter and trauma to the spinal cord. We report a case of intercostal misplacement of an epidural catheter in a 66-year-old patient who scheduled for left thoracotomy.

The Aspiration of Injected Air via an Epidural Catheter as an Indicator for Appropriate Placement of the Catheter in the Epidural Space

BACKGROUND: The "gold standard" for proper epidural catheter positioning is a clinical response, as assessed by a pinprick test. Yet it may take time or it may be difficult to perform this test after epidural catheter placement in sedated or uncooperative patients or during general anesthesia. We assessed the usefulness of aspirating injected air via an epidural catheter as an indicator of correct epidural catheter placement. METHODS: We surveyed 200 patients who underwent surgery under general or epidural anesthesia. A Tuohy needle was inserted into the epidural space with using the hanging drop technique. After placement of the epidural catheter, 3 ml of air was injected via the catheter, and then the volume of aspirated air was measured. RESULTS: The mean volume of aspirated air was 2.3 +/- 0.7 ml (75% of the injected air volume) and this ranged from 0 to 3 ml. CONCLUSIONS: Aspiration of injected air is a simple alternative method for identifying the appropriate placement of epidural catheters in the epidural space.

Seguimento de cateter peridural para analgesia pós-operatória / The follow-up of the use of peridural catheter in the analgesia post surgery

Introdução: Uma forma bastante eficiente de analgesia pós-operatória é através de injeção de fármacos por via peridural. Para isso é mantido cateter peridural e a principal complicação é saída do cateter. Outras complicações que podem ocorrer são: dobra, migração para espaço subaracnóideo, secção, perda da conexão e infecção. Objetivo: Avaliar a eficácia analgésica e verificar a incidência de complicações relacionadas ao cateter para analgesia pós-operatória. Método: Foram acompanhados pacientes com cateter peridural no período de novembro de 2006 a abril de 2007. Resultados: Foram avaliados 32 pacientes e a média do tempo de permanência do cateter foi de 4,3 dias. Houve 3 (9,3%) complicações: 2 (6,3%) saídas de cateter e 1 (3,1%) Proteus mirabillis na cultura de ponta do cateter. A satisfação dos pacientes com a técnica ocorreu em 16 (50%) dos pacientes. Conclusão: O uso de cateter peridural para analgesia pós-operatória promove benefícios em grande parcela dos pacientes, sem complicações significativas.

Accidental intrapleural positioning of an epidural catheter in a patient undergoing a right pneumonectomy: A case report / 대한마취과학회지

Thoracic epidural analgesia is a common method of pain relief for thoracic and upper abdominal surgery. Misplacement of the epidural catheter is one of the complications associated with epidural analgesia. A 60-year-old man was scheduled for a right pneumonectomy under general anesthesia. Before inducing general anesthesia, the patient was placed in the left lateral decubitus position. A 18-gauge Tuohy needle was inserted into the T6-T7 level using the left paramedian approach 1.5 cm lateral to the midline with a loss of resistance at 7 cm, and uneventful catheter advancement was performed. Approximately 30 minutes after commencing surgery, the surgeon found the epidural catheter in the right pleural cavity. We report a case of the accidental intrapleural positioning of a thoracic epidural catheter.

The Breakage of Epidural Catheter during Continuous Epidural Analgesia for Cancer Pain: A case report / 대한마취과학회지

During pain control by continuous epidural analgesia, the breakage of epidural catheter is a very rare complication. We experienced breakage of epidural catheter in patient of cancer pain during continuous epidural analgesia. We performed epidural catheterization between T12 and L1 level for pain control. After 6 weeks of epidural catheterization, abruptly patient complained severe pain. When we applied negative pressure to catheter by syringe before epidural injection of bolus dose, a few airs were aspirated. We strongly suspected breakage of catheter, and the breakage in 1617 cm from epidural catheter tip was confirmed by normal saline administration via epidural catheter. After new epidural catheter inserted again, patient's pain was controlled by VAS 24 and another complications were not appeared. We must carefully manage the catheter because of complications of epidural catheter.