Minimally Invasive Surgery to Remove a Broken and Retained Epidural Catheter Fragment

Abstract

Epidural anaesthesia (EA) has consistently been used for treatments affecting the pelvis, lower limbs, lower abdomen, and perineum; however, it is progressively employed as a single anaesthetic or supplement to general and spinal anaesthesia for a broader range of procedures. The retention of a broken epidural catheter piece is an uncommon but well-known complication. In this report, we present a 30-year-old male with avascular necrosis (AVN) of the hip who was referred for total hip replacement (THR). An epidural catheter had been placed at the presumed L2-3 interspace to administer EA. The catheter had been set too deep and it broke on extraction with the Tuohy needle, leaving a fragment inside. The patient was then given general anaesthesia and the planned procedure of THR was done in the lateral position. The patient was then shifted to the prone position to remove the retained fragment of the epidural catheter by a minimally invasive spinal surgery (MISS). Right-sided L2 laminotomy was done, as the epidural catheter was inserted from the right side, to retrieve the broken fragment without any added postoperative neurological complications. MISS may be attempted by experienced surgeons for the removal of a retained fragment of the epidural catheter from the spinal canal before adhesion as a safe option.

Broken Needle Embedded in the Body during Vascular Puncture

“…The incidence of a broken needle or needle breakage is not unknown. Broken needles have been reported during dental procedures [ 2 , 3 ], laparoscopy [ 4 ], surgical operation [ 1 ], percutaneous needle biopsy [ 5 ], endobronchial ultrasound-guided-transbronchial needle aspiration [ 6 ], antegrade suture passer of shoulder [ 7 ], bone biopsy [ 8 ], acupunctures [ 9 ], spinal anesthesia [ 10 , 11 ], and the injection of drugs [ 12 , 13 ]. Seven case reports of broken needles during various procedures were reported in 2021 from a PubMed ® search.…”

Reta Epidurinės Analgezijos Komplikacija. Klinikinio Atvejo Analizė

“…Įvykus šiai komplikacijai, anesteziologams dažnai kyla dilema, nes nėra pakankamai informacijos apie tokius atvejus ir nepakanka literatūros, kokia taktika būtų optimaliausia. Epidurinio tarpo kateterizacija yra gana saugus metodas, keliantis mažą komplikacijų riziką [5].…”

“…Pagrindiniai gydymo variantai: fragmentą palikti ir informuoti pacientą apie svarbius simptomus; pasikonsultuoti 49 su neurochirurgu; jei yra neurologinių simptomų, svarstyti dėl operacinio gydymo [5]. Išvados 1.…”

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…”

“…Spine surgery is not without its own complications, with 1 case of surgical site infection 13 and 2 cases of transient postoperative lower back pain treated with physiotherapy. 30,34 From our review, factors that may influence the decision to operate have been summarised in Table 1.…”