Epidural Catheter Migration: A Case Report of a CT Scan Examination

Abstract

Epidural catheter placement is one of the most effective, secure, and worldwide used pain control modalities. Epidural catheter dislodgment is a common cause of epidural block failure. The diagnosis of this situation is usually presumptive, and cases in which the actual trajectory and final location of the catheter are witnessed by imaging are rare.We present two cases of the insufficient epidural block due to catheter migration, confirmed by a CT scan with radiopaque contrast injection through the catheter. In the first case, the catheter tip was identified in the left major psoas muscle. Some catheter holes were probably located in a border zone between two compartments, which made the analgesic efficacy dependent on the infusion rate. In the second case, the catheter tip was identified as lodged in the left paravertebral space, which explains only unilateral left pain relief.In selected situations, like repeated ineffectiveness and in pretended long-duration catheters, imaging tests may be useful to determine the actual position of the catheter and identify anatomical variations that may lead to an incorrect replacement.

A Case Report of Caudal Migration of a Lumbar Epidural Catheter Confirmed by Doppler Ultrasound: Ultrasound to the Rescue!

“…Numerous methods of confirming epidural catheter placement have been reported including but not limited to electrical stimulation as described by Tsui et al [ 11 ], interpretation of epidural pressure waveforms as described by Ghia et al [ 12 ], CT epidurography [ 13 ], contrast injection, and X-ray confirmation. These methods are technically difficult and require special equipment.…”

Fluoroscopy to confirm transforaminal exit of an epidural catheter

“…This confirmation is only possible however in patients who have received an epidural rather than an epidural as part of a CSE or if a general anaesthetic is administered before the development of sensory loss. Despite several advancements in epidural catheter material and tip designs, malpositioned epidural catheters continue to occur [1][2][3]. It is reported that 27% of lumbar epidurals fail but, in many cases, the underlying cause for the failure is undetermined [4].…”