Failed epidural top Arvind up due to a kinked epidural catheter Introduction: Epidural catheter kinking is a rare complication of lumbar epidural analgesia. There have been few previous reports of the epidural catheter kinking in the subcutaneous tissue or dermis after initial successful functioning[1]. The rate Karthikeyan Case Report: & Lisa Stevens • 30yo female, G1P0, 39/40 gestation • Epidural inserted for analgesia • Loss of resistance 5.5cm, secured 10cm at the skin • Worked well during labour • Cat 2 caesarean called for non-reassuring CTG of failed epidural anaesthesia ranges from 13% to 47%[2]. References Figure 1: Kinked epidural catheter • Epidural block assessed: patient pain-free and block to T6 bilaterally with ice test • Epidural top up: • 100mcg fentanyl and 5mLs 2% lignocaine with 1:200 000 adrenaline via epidural with no issues • No kinks or disconnections external part of the catheter • A further dose of lignocaine with adrenaline attempted to be administered, met with resistance and the plunger on the syringe was unable to be advanced • Catheter pulled back 1cm and a further 2x doses of lignocaine with adrenaline were given with no resistance • Epidural block assessed as adequate for surgical anaesthesia • Surgery commenced and patient initially tolerated surgery well • When surgeon was deep in the abdomen, patient felt intense pain and had to convert to GA • At the end of the case, firm traction was required to remove the epidural catheter • It was found that the epidural catheter was completely kinked at the 9cm mark beneath the skin (See figure 1) : [1] Journal of Anaesthesiology, Epidural catheter kinking: an appalling experience, 2023 Jan-Mar; 39(1): 142-143. hps://www.ncbi.nlm.nih.gov/pmc/arcles/PMC10220175/ [2] Saudi Journal of Anaesthesia, A kinked epidural catheter, 2019 Apr-Jun; 13(2): 158-159. hps://www.ncbi.nlm.nih.gov/pmc/arcles/PMC6448422/ [3] Hippokraa Medical Journal, Management and visualisaon of a kinked epidural catheter, 2010 Oct-Dec; 14(4): 294- 296. hps://www.ncbi.nlm.nih.gov/pmc/arcles/PMC3031330/