Broken Epidural Catheter: An Anesthesiologist’s Dilemma

Abstract

Epidural anesthesia is a safe procedure and is routinely performed by the anesthesiologists. Breakage of an epidural catheter is a rare, but a worrisome complication. However, if this happens, the presence of retained epidural catheter fragment should be properly documented and should also be informed to the surgical team and the patient. Here, we present two cases of such an event and also highlighting the common reasons that could have precipitated that event.

Fractured epidural catheter with retained fragment in the epidural space—a case study and proposed management algorithm

“…It was first reported in the literature in 1957 and there is no consensus on management; the major decision lies between leaving an asymptomatic retained fragment in situ or surgical exploration with removal. 1 , 2 …”

“…Sardana, Mitra, and colleagues 1 , 2 advise that the fragment may be left alone in most cases, arguing that any sequestered catheter fragment is inert so should produce no foreign body reaction, whereas surgical removal could do more harm than good. Reena and Vikram 3 suggest that surgery should be reserved only for symptomatic cases without clear definition of what constitutes a symptom(s) in this situation.…”

“…A broken epidural catheter with a retained fragment in the spinal canal—first reported in 1957—is a rare complication of an otherwise low risk procedure; it is estimated to occur in 0.002% of cases of catheter insertion and there is no management consensus. 1 , 2 …”

When The Unexpected Happens: The Intriguing Retrieval of a Broken Epidural Catheter

“…According to Sardana et al, [ 7 ] and Mitra and Fleischmann [ 8 ] the fragment may be left alone in most cases, arguing that any sequestered catheter fragment is inert and should produce no foreign body reaction, whereas surgical removal could do more harm than good. If a catheter fragment is retained within the spinal canal, Tarukado et al, [ 9 ] propose that surgery should be considered before adhesions advance, while Ugboma et al [ 10 ] recommend aggressive surgical exploration and extraction, even in asymptomatic patients.…”

Retained epidural catheter: an update

“…We found 5 (13.8%) cases whereby a fragment was sheared off as a result of being cut by the Touhy needle as it was withdrawn through it [24][25][26][27][28] and 4 (11.1%) cases of fragments fracturing from excessive force during extraction together with the Touhy needle. 16,29,30 There were 2 cases where the retained catheters were incidental findings many years after insertion 31,34 and 1 case of migration to the paravertebral space. 33…”