Inserción intrapleural involuntaria de un catéter epidural en cirugía torácica: ¿está fuera de juego la analgesia regional o existe otra salida? |
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| Institution: | 1. Department of Anesthesiology, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal;2. Department of Anesthesiology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal;3. Thoracic Surgery, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal;1. Servicio de Anestesiología y Reanimación, Hospital General, Hospital Universitario Virgen del Rocío, Sevilla, España;2. Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Sevilla, España;3. Grupo de Innovación Tecnológica, Hospital Universitario Virgen del Rocío, Sevilla, España;1. Adult Intensive Care Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina;2. Unidad de Anatomía Patológica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina;1. Examinations Committee of the European Society of Anaesthesiology and Intensive Care (ESAIC);2. Department of Anaesthesiology and Intensive Care, Hospital Universitario La Paz, Madrid, España;3. Department of Anaesthesia and Intensive Care, Torbay Hospital, Torquay, UK;4. Department of Anaesthesiology and Intensive Care, Yerevan State Medical University, Erebouni Medical Centre, Yerevan, Armenia;5. Department of Anaesthesia, University Hospital of Wales, Cardiff, UK;6. Department of Anaesthesiology and Intensive Care Medicine, Offenburg Hospital, Offenburg, Germany;7. Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, RKH-Klinikum Ludwigsburg, Ludwigsburg, Germany;8. Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary;9. Department of Anaesthesiology, Pain Medicine and Intensive Care, Akershus University Hospital, Nordbyhagen, Norway;10. Department of Anaesthesia and Intensive Care Medicine, Mater Dei Hospital, Msida, Malta;1. Servicio de Anestesia y Reanimación, Hospital Universitario Gregorio Marañón de Madrid, Unidad de Anestesia Pediátrica, Madrid, España;2. Servicio de Neonatología, Hospital Universitario Gregorio Marañón de Madrid, Madrid, España |
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| Abstract: | In thoracic surgery, optimized pain control is crucial to prevent dysfunction in cardiorespiratory mechanics. Epidural anesthesia and paravertebral block are the most popular techniques for analgesia. Unintended intrapleural insertion of an epidural catheter is a rare complication.Our report presents a case of a patient submitted to pulmonary tumor resection by video-assisted thoracoscopic surgery. There was difficulty in epidural insertion related to patient's obesity, but after general anesthesia induction, no additional intravenous analgesia was needed after epidural injection. Surgery required conversion to thoracotomy, with intrapleural identification of epidural catheter. At the end of surgery, surgeons reoriented catheter to paravertebral space, with leak absence confirmation after local anesthetic injection through the catheter. In postoperative period, pain control was efficient, with no complications.It was a successful case that shows that when we find unexpected complications, we can look for alternative solutions to give our patient the best treatment. |
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| Keywords: | Thoracic epidural Paravertebral block Thoracotomy Regional anesthesia Anesthesia complications |
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