Epidural catheter entrapment

Canadian Journal of Anesthesia/Journal canadien d'anesthésie -     

Epidural stimulator catheter

The idea epidural test should be safe and easy to use with readily available materials and monitoring devices. One should also be able to use the test to reliably detect incorrectly placed epidural cathetes while performing the procedure. This would allow adjustments to be made at the time of insertion. Electrical stimulation methods are well accepted for identifying peripheral nerves when performing regional anesthesia. However, these methods have never been used to confirm catheter placement in the epidural space until recently. This article provides a brief review of the new concept of using electrical stimulation to confirm epidural catheter location and outlines recent clinical experiences with this important advance in epidural anesthesia. Copyright 2002, Elsevier Science (USA). All rights reserved.     

Epidural catheter migration during labour

A study was undertaken to determine the incidence, magnitude and direction of catheter migration in 100 patients who had epidural analgesia for pain relief in labour. Over 50% of catheters migrated from the original position at siting. The relevance of this migration and the usefulness of its measurement are discussed.     

Epidural catheter breakage: a possible mechanism

The breakage of an epidural catheter within a patient is an uncommon but troublesome complication of continuous epidural block, and its cause is rarely discovered. Several possible mechanisms for catheter breakage have been proposed, but few can be reproduced experimentally. Review of two recent medicolegal cases concerning catheters that were severed at the time of insertion led to laboratory studies in an attempt to find an explanation. The results of this work demonstrated that it was possible to break or severely damage an epidural catheter by heavy contact between the tip of the epidural needle and a bony surface, if a length of the catheter was protruding from the tip.     

Epidural catheter migration: a comparison of tunnelling against a new technique of catheter fixation

We investigated the efficacy of a new technique of epidural catheter fixation that relies on a strip of adhesive foam transfixed by a securing suture. We compared this technique to a tunnelled technique in a prospective, randomized trial (n = 25 in each group). Epidural catheter depth was recorded at the time of insertion and at the time of removal. Clinically significant catheter movement was considered as > 2 cm outward movement or > 1 cm inward movement. The mean duration of epidural analgesia was five days for both groups. Clinically significant movement was noted in eight patients (32%) in the tunnelled group and seven patients (28%) in the sutured group (P = 0.75). Movement of the epidural catheter did not correlate with analgesic failure. The sutured technique provided similar protection against migration to tunnelling but any potential advantages were offset by concerns about a significantly higher incidence of erythema around the catheter exist site in the sutured group (1 vs 6 patients, P = 0.04).     

Epidural abscess after epidural catheter for pain release during pancreatitis

BACKGROUND: Despite knowledge about compromised host defence in the course of diabetes mellitus and pancreatitis, epidural analgesia (EA) is recommended for pain management during pancreatitis. CASE REPORT: We present the case of a diabetic patient with pancreatitis who developed an epidural abscess after 3 days with an epidural catheter. Natural killer and T-helper cell counts were distinctively reduced in the absence of HIV serology. Furthermore, a synthesis failure of the liver was observed and evidenced by low cholinesterase, low whole protein fraction and low antithrombin III in the peripheral blood. CONCLUSION: We suggest that the combination of pancreatitis, diabetes and compromised immunity might be a contraindication to epidural analgesia.