Transforaminal escape of a lumbar epidural catheter

Halpenny, David; Loken, R. G.; Williams, John A.

doi:10.1007/bf03008325

Cited by 13 publications

(4 citation statements)

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“…Sanchez et al reported that six of ninety (6.6%) lumbar epidural catheters had passed out of the epidural space 8 . Halpenny et al described this during a right-sided radical nephrectomy for carcinoma 9 , in which the lumbar epidural catheter was visualized in the paravertebral tissues after mobilization of the kidney.…”

Section: Discussionmentioning

confidence: 99%

Pleural Puncture: An Unusual Complication of a Thoracic Epidural

Grieve

Whitta

2004

Anaesth Intensive Care

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Thoracic epidural analgesia is a common method of pain relief for major thoracic and abdominal surgery. Numerous complications may occur, including temporary or permanent neurological injury 1. A rare and potentially lifethreatening complication of thoracic epidural analgesia is pleural puncture by the needle or the catheter. Such a case is presented and pleural puncture in association with attempted thoracic epidural catheter placement is discussed.

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Section: Discussionmentioning

confidence: 99%

Pleural Puncture: An Unusual Complication of a Thoracic Epidural

Grieve

Whitta

2004

Anaesth Intensive Care

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“…The most common area they are misplaced is in the intervertebral foramen. Failed pain management or spinal/tissue damage may occur when the catheter is misplaced [5]. …”

Section: Discussionmentioning

confidence: 99%

Intercostal misplacement of a thoracic epidural catheter -A case report-

Kim

Lee

2010

Korean J Anesthesiol

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“…However, identification of the epidural space itself using the loss-of-resistance technique seems to be more difficult with the paramedian approach and may result in a higher complication rate, especially when the catheter passes out through a foramen on the opposite side [23][24][25]. The use of the midline approach is not free from this complication [26]. Only the choice of a soft catheter would appear to minimise the chances of transforaminal escape [27].…”

Section: Discussionmentioning

confidence: 99%

Accidental pleural puncture by a thoracic epidural catheter

Zaugg¹,

Stoehr²,

Weder³

et al. 1998

Anaesthesia

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SummaryWe report the occurrence of an accidental pleural puncture by an epidural catheter that happened during the attempted induction of thoracic epidural anaesthesia using a paramedian approach in an awake patient. The incorrect placement of the catheter was recognised while the patient was undergoing thoracoscopic surgery. The possibility of accidental pleural puncture during attempted thoracic epidural catheter placement by either the paramedian or the midline approach should be borne in mind. A misplaced catheter may injure lung tissue and result in a potentially dangerous intra-operative tension pneumothorax.Keywords Anaesthetic techniques, regional; epidural, thoracic. Complications. ...................................................................................... Correspondence to: Dr A. Zollinger Accepted: 23 March 1997 Thoracic epidural anaesthesia is frequently used in combination with general anaesthesia to achieve excellent peri-operative analgesia in patients undergoing upper abdominal and thoracic surgery [1, 2]. The technique may be associated with beneficial respiratory and haemodynamic effects [3][4][5]. However, this procedure is not free from complications, which include dural puncture with high spinal block [6, 7], blood vessel puncture with subsequent formation of an epidural haematoma [8,9], prolonged arterial hypotension, transection and knotting of the catheter [10], infection [11,12] and neurological sequelae [13]. Only a few cases of accidental puncture of the pleural cavity after thoracic epidural anaesthesia have been reported [14][15][16]. We report a case with direct intraoperative visualisation of the thoracic epidural catheter perforating the parietal pleura in a patient undergoing video-assisted thoracoscopic surgery. Case historyA 73-year-old female patient (height: 149 cm, weight: 60 kg) with chronic pneumonia of the right lower lobe was referred for diagnostic thoracoscopic lung biopsy. Her chest X-ray showed an encapsulated pleural effusion in the midzone of the right lung. Pre-operative laboratory data, lung-function tests and electrocardiogram were all normal. The patient had no history of spinal pathology.Routine monitoring was attached to the patient, who was positioned in the right lateral position with her knees bent and her spine flexed. The space between the spinous processes of the sixth and seventh thoracic vertebrae (T 6/7 interspace) was infiltrated with local anaesthetic. A 16G Tuohy needle (Portex Ltd, Hythe, Kent, UK) was inserted into the T 6/7 interspace using a right-sided paramedian approach (2 cm to the right of the midline). The loss-ofresistance technique was used with the aid of a 10-ml saline-filled glass syringe. The needle was advanced perpendicular to the skin until it hit the vertebral lamina on the right side. The tip of the needle was then redirected in the mediocranial direction and the typical loss of resistance was felt 7 cm deep to the skin. The epidural catheter was threaded 3 cm beyond the tip of the needle without any problems...

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Transforaminal escape of a lumbar epidural catheter

Cited by 13 publications

References 4 publications

Pleural Puncture: An Unusual Complication of a Thoracic Epidural

Pleural Puncture: An Unusual Complication of a Thoracic Epidural

Intercostal misplacement of a thoracic epidural catheter -A case report-

Accidental pleural puncture by a thoracic epidural catheter

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