Fracture of the epidural catheter tip during epidural anesthesia

Abstract

Introduction: Epidural anesthesia is a neuraxial technique that is widely used for surgical, obstetric, and chronic pain management. It involves injecting an anesthetic material into the epidural space through the intervertebral space using an epidural needle. Epidural anesthesia may result in complications including epidural hematoma, epidural abscess, and shearing of the epidural catheter. Breakage of the tip of the epidural catheter is a rare complication. Patient concerns: A 27-year-old primigravid woman, previously well, was admitted for normal vaginal delivery, for which she received epidural analgesia. After delivery, the epidural catheter was removed and the tip was missing. Diagnoses: A neurosurgical consultation requested magnetic resonance imaging of the lumbar spine with intravenous contrast. Magnetic resonance imaging failed to reveal any missing part. Interventions: A multidisciplinary team deferred surgical removal of the tip and followed-up with the patient. Outcomes: Weekly follow-up of 3 months showed no symptoms or neurological sequelae. Conclusions: Breakage of the epidural catheter tip is an infrequent complication of epidural anesthesia. An expert physician should insert or remove the epidural catheters. The decision between conservative and surgical management should be case-based, with open discussion with the patient.