Entrapping of Epidural Catheter after Postoperative Epidural Pain Control: A case report

Park, Jung Wook; Lee, Bong Jae

Abstract

The insertion of an epidural catheter into the epidural space to control postoperative pain is very common, as the technique is safe, effective and easy to perform. The numbers of documented problems are remarkably few, particularly those encountered during removal of the catheter. A 65-year-old man with stomach cancer was scheduled for a subtotal gastrectomy. The patient requested epidural analgesia for postoperative pain control. The patient was placed in the right decubitus position, and a 17-gauge Arrow Tuohy needle was inserted midline at the T12-L1 vertebral interspace, with the epidural space located using the loss-of-resistance technique. A 19-gauge Arrow Flextip PlusTM epidural catheter was inserted and advanced 5 cm into the epidural space, without difficulty or resistance. Two days after the administration of epidural analgesia, when the effects of local analgesics and opioid had worn off, an attempt was made to remove the catheter in the sitting position. Increased pressure was applied, but the catheter stretched and the wire reinforcement within the catheter began to uncoil. The removal of the epidural catheter was stopped at this point. After three hours, the patient was placed in the right lateral decubitus position, with his legs flexed to his chest, and another attempt to remove the catheter was successful. Herein, a case of difficulty in removing an obstinate epidural catheter is reported.