Keywords
Abstract
The retained catheter fragment is a rare complication when performing epidural techniques. There is a paucity of studies available, with Australian data quoting an incidence of 1 in 60,000. For this article, we reviewed 36 case reports of retained epidural catheters between 1995 and 2020. The case reports found computed tomography scans to be the most reliable modality to investigate a retained epidural catheter. The decision to surgically remove or treat conservatively should be multidisciplinary with most operations involving symptomatic or long fragments. In our review, we found 25 (69.4%) reports of surgical removal, with 21 opting for immediate removal. Conservatively treated retained fragments should be monitored for neurological or infective complications. Patients should receive a follow-up plan and be educated regarding red flag symptoms to facilitate further management. For future reference, a detailed documentation of the incident, parties involved, discussions, and decisions should be made.
References
Collier C. Epidural Catheter Breakage: A Possible Mechanism. Int J Obstet Anesth. 2000;9(2):87-93. https://doi.org/10.1054/ijoa.1999.0354
Lee Y-H, Hwang HY, Sim W-S, Yang M, Lee CJ. Breakage Of A Thoracic Epidural Catheter During Its Removal-A Case Report. Korean J Anesthesiol. 2010;58(6):569-72. https://doi.org/10.4097/kjae.2010.58.6.569
Ugboma S, Au-Truong X, Kranzler LI, Rifai SH, Joseph NJ, Salem MR. The Breaking Of An Intrathecally-Placed Epidural Catheter During Extraction. Anesth Analg. 2002;95(4):1087-9. https://doi.org/10.1097/00000539-200210000-00055
Zahid Z, Zbeidy R. Retained Epidural Catheter: A Case Report Of A Pregnant Woman And A Literature Review Of Prevalence, Etiology, And Management. Journal Of Medical Research And Health Education. 2018;2:2.
Blanchard N, Clabeau J-J, Ossart M, Dekens J, Legars D, Tchaoussoff J. Radicular Pain Due To A Retained Fragment Of Epidural Catheter Anesthesiology. 1997;87(6):1567-9. https://doi.org/10.1097/00000542-199712000-00036
Tarukado K, Oda T, Tono O, Suetsugu H, Doi T. A Retained Epidural Catheter Fragment Treated By Surgery. Asian Spine J. 2015;9(3):461-4. https://doi.org/10.4184/asj.2015.9.3.461
Anwari JS, Al-Wahbi Y, Al-Nahdi S. A Broken Catheter In The Epidural Space. Neurosciences (Riyadh). 2014;19(2):138-41. PMID: 24739413
Arun N, Kumar M, Pankaj S. Retained Broken Epidural Catheter: What To Do? Journal Of Indira Gandhi Institute Of Medical Sciences. 2020;6(1):90.
Gehan G, Mongolfier R, Coulon JM, Mahanna B, Bahloul H. Rupture D’un Cathéter Péridural, Devenir De L’extrémité Laissée En Place. À Propos D’un Cas. Ann Fr Anesth Reanim. 2010;29:403-4. https://doi.org/10.1016/J.ANNFAR.2010.03.004
Hippalgaonkar AV, Kudalkar AG, Gaikwad SM, Modak S, Gupta HB, Tendolkar BA. Successful Management Of A Broken Epidural Catheter!!! Saudi J Anaesth. 2017;11(2):228-31. https://doi.org/10.4103/1658-354x.203029
Payal Shah SR, Monika Mahajan, Usha K Chaudhary, Vrinda Chauhan, Ajay Verma. Retained And Broken Epidural Catheter: A Case Report. Journal Of Dental And Medical Sciences. 2019;18(7). https://doi.org/10.9790/0853-1807057072
Sheehan C, Sodhi V. Retained Epidural Catheter Tip. Int J Obstet Anesth. 2012;21(4):389-90. https://doi.org/10.1016/j.ijoa.2012.07.001
Tina M Yu MN, Solmaz P Manuel. Surgical Management Of The Retained Epidural Catheter Fragment Complicated By Postoperative Phlegmon. J Anest & Inten Care Med. 2018;5. https://doi.org/10.19080/JAICM.2018.05.555660
Drake E, Chapman K. Can You Perform Regional Anaesthesia In Proximity Of A Retained Fragment Of Epidural Catheter? Int J Obstet Anesth. 2021;47. https://doi.org/10.1016/j.ijoa.2021.103194
Gompels B, Rusby T, Slater N. Fractured Epidural Catheter With Retained Fragment In The Epidural Space—A Case Study And Proposed Management Algorithm. BJA Open. 2022;4:100095. https://doi.org/10.1016/j.bjao.2022.100095
Patel A, Adsul N, Mahajan S, Chahal RS, Kalra KL, Acharya S. Incidental Unintentional Breakage Of Epidural Catheter In Supralaminar Area: A Case Report. Surg Neurol Int. 2021;12:129. https://doi.org/10.25259%2FSNI_745_2020
Chang P-Y, Hu J, Lin Y-T, Chan K-H, Tsou M-Y. Butterfly-Like Knotting Of A Lumbar Epidural Catheter. Acta Anaesthesiologica Taiwanica. 2010;48(1):45-8. https://doi.org/10.1016/S1875-4597(10)60010-0
Esqueda-Arriaga MA, Martínez-Arriaga GJ. Surgical Removal Of Retained Epidural Catheter. A Case Report. Revista Mexicana De Anestesiología. 2009;32(3):191-5.
Yallapragada SV, Vemuri NN, Shaik MS. A Knotty Affair. Southern African Journal of Anaesthesia and Analgesia. 2015;21(2):49-50. https://doi.org/10.1080/22201181.2015.1028221
Molina-García RA, Muñoz-Martínez AC, Hoyos-Pescador R, De La Torre-Espinosa R. Retained Epidural Catheter: A Rare Complication. Report Of Two Cases. Colombian Journal of Anesthesiology. 2017;45:4-7. https://doi.org/10.1016/j.rcae.2016.02.009
A. Orfi PYD, J.F. Brichant. Knotted Epidural Catheter: The Role of Determining A Catheter’s Ultimate Tensile Strength Before Pulling On It. A Case Report and Literature Review. Acta Anaesth Belg. 2020;71:95-100.
Renehan EM, Peterson RA, Penning JP, Rosaeg OP, Chow D. Visualization Of A Looped And Knotted Epidural Catheter With A Guidewire. Can J Anesth. 2000;47(4):329-33. https://doi.org/10.1007/bf03020947
Al-Kayed O, Al-Bouti F, Ababneh M. Surgical Removal Of A Looped And Knotted Epidural Catheter In A Postpartum Patient--A Case Report. Middle East Journal Of Anaesthesiology. 2008;19(4):913-8. PMID: 18630778
Chhabada R RS, Malik S, Pangam H. A Rare Presentation Of Broken Epidural Catheter. Journal Of Anaesthesia and Critical Care Case Reports. 2020;6(2):23-4. https://doi.org/10.13107/jaccr.2020.v06i02.152
Gulcu N, Karaaslan K, Kandirali E, Kocoglu H. Detection Of A Retained Epidural Catheter Fragment. Reg Anesth Pain Med. 2006;31(6):589. https://doi.org/10.1016/j.rapm.2006.08.004
Noblett K, Mckinney A, Kim R. Sheared Epidural Catheter During An Elective Procedure. Obstet Gynecol. 2007;109(2 Pt2):566-8. https://doi.org/10.1097/01.aog.0000253246.56575.84
Agustín S, Martín Pérez De P, Lorena D. Sectioned Epidural Catheter. Revista Médica Del Uruguay. 2022;38(2). https://doi.org/10.29193/RMU.38.2.11
Staats PS, Stinson SM, Lee RR. Lumbar Stenosis Complicating Retained Epidural Catheter Tip. Anesthesiology. 1995;83(5):1115-8. https://doi.org/10.1097/00000542-199511000-00027
Sardana DK, Panaych K, Samra T. Broken Epidural Catheter: An Anesthesiologist’s Dilemma. J Case Rep. 2017;7(1):116-8. https://doi.org/10.17659/01.2017.0032
Walia S, Pisal T, Kandari A, Jivrajani P. Minimally Invasive Surgery To Remove A Broken And Retained Epidural Catheter Fragment. Cureus. 2022;14(5):E25255. https://doi.org/10.7759/cureus.25255
Pinciroli R, Fumagalli R. The Unexpected Epidural: A Case Report. BMC Anesthesiology. 2015;15(1):1-5. https://doi.org/10.1186%2Fs12871-015-0062-4
Castro AFO MC, Souza, PDM RR, Mota VJD, Mendonça, NA. Case Report: Peridural Cateter Rupture During Anesthetic Act. Revista De Patologia Do Tocantins. 2020;7(1). https://doi.org/10.20873/uft.2446-6492.2019v6n3p56
Fernandes RC, Mendes ÂB, Gomes MJ, Viana PB, Lages NR. When Radiology Determines The Success Of Removal Of A Retained Epidural Catheter: A Case Report. Saudi J Anaesth. 2020;14(2):231. https://doi.org/10.4103%2Fsja.SJA_601_19
Ishikawa Y, Imagama S, Ito Z, Ando K, Gotoh M, Nishiwaki K, Et Al. Delayed Onset Of Subdural Hematoma Following Epidural Catheter Breakage. Global Spine Journal. 2015;6(1):1-6. https://doi.org/10.1055/s-0035-1549030
Morris GN, Warren BB, Hanson W, Mazzeo FJ, DiBenedetto DJ. Influence of Patient Position on Withdrawal Forces during Removal of Lumbar Extradural Catheter. Br J Anaesth. 1996;77:419-420. https://doi.org/10.1093/bja/77.3.419