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Retained Epidural Catheter Requiring Exploratory Laminectomy
Ali Azadegan, M.D.; Lauren Steffel, M.D.; Michelle Han, M.D.
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
Department of Anesthesiology, VA Puget Sound Medical Center, Seattle, Washington
Complications associated with epidural anesthesia and analgesia are uncommon. They include epidural abscess, hematoma formation, radiculopathy, and catheter knotting and breakage. Catheter retention due to knotting and knot-less catheter entanglement are exceedingly rare, with an estimated incidence of 0.0015%. Herein, we describe a case of a retained epidural catheter necessitating surgical removal.
A 70-year-old ASA III male with history of muscle-invasive bladder cancer, atrial fibrillation, and cutaneous T-cell lymphoma (involving 80% body surface area) presented for radical cystectomy. Pre-operatively, a straightforward paramedian epidural placement was performed by the attending anesthesiologist at the T10–T11 interspace (loss of resistance 6 cm), following two unsuccessful midline approaches at T9–T10 and T10–T11 by the resident trainee. The catheter was threaded without resistance into the epidural space; however, after withdrawal of the Tuohy needle, the catheter could not be retracted past its 13-cm mark. The catheter location was confirmed with an appropriate sensory level to ice. Patient remained hemodynamically stable and asymptomatic while awaiting transfer to the operating room. The operation was, however, ultimately cancelled due to a brief syncopal episode and hypotension upon transfer of the patient to the operating room table. Subsequently, multiple attempts at removal of the epidural catheter using steady, gentle traction were met with resistance at 13 cm. Patient repositioning and injection of sterile saline into the catheter were ineffectual. Non-contrast CT revealed an epidural catheter entering the epidural space through a calcified ligamentum flavum, adjacent to a left hypertrophic degenerative facet. Neurosurgical consultation recommended surgical removal of the retained catheter. Intraoperatively, the catheter tip was found in the epidural space, and the catheter was successfully removed in its entirety via exploratory laminectomy. The patient suffered no short- or long-term neurologic sequelae.