Indian Journal of Anaesthesia

LETTER TO EDITOR
Year
: 2012  |  Volume : 56  |  Issue : 2  |  Page : 205-

Re: A rare complication of epidural anaesthesia. A case report with brief review of literature


Adriano BS Hobaika 
 Department of Anaesthesiology, Hospital Mater Dei, Belo Horizonte, Brasil

Correspondence Address:
Adriano BS Hobaika
R. Des. Jorge Fontana 336/1701, BH, MG, Brasil. CEP 30320670.




How to cite this article:
Hobaika AB. Re: A rare complication of epidural anaesthesia. A case report with brief review of literature.Indian J Anaesth 2012;56:205-205


How to cite this URL:
Hobaika AB. Re: A rare complication of epidural anaesthesia. A case report with brief review of literature. Indian J Anaesth [serial online] 2012 [cited 2020 Aug 14 ];56:205-205
Available from: http://www.ijaweb.org/text.asp?2012/56/2/205/96315


Full Text

Sir,

I read with interest the article titled, "A rare complication of epidural anaesthesia a case report with brief review of literature" by Lala et al. [1] The authors cite some methods to remove a catheter with increased resistance. It is interesting to note that there are some other recommendations to prevent the breakage of an epidural catheter. [2] Removal should always be performed by an anaesthesiologist or trained personnel because, in two cases, the catheter broke when non-trained personnel removed the catheter. [3],[4] Removal should be done cautiously, applying continuous force, avoiding the use of excessive force. Prehension devices, such as haemostatic forceps, should never be used. The patient should be positioned in lateral decubitus for an easier removal. When facing a difficult catheter removal, one can inject normal saline through the catheter before another attempt. [5],[6] Some authors recommend waiting 30-60 min before another attempt. Although this conduct lacks a logical explanation, it was effective in two cases of difficult catheter removal. [7],[8] The experience of pain during the removal might indicate that the catheter is tangled around a nerve root. Because of the possibility of nerve root avulsion, the catheter should be removed under direct visualization through a laminectomy. In one case of a difficult catheter removal, a sterile Tuohy needle was introduced in the epidural space using the catheter as a guide; the needle and the catheter were removed as one set. Although this method was successful in the case described, it has a clear risk of catheter breakage and, therefore, this technique is not recommended. [9]

References

1Lala PS, Langar V, Rai A, Singh R. A rare complication of epidural anaesthesia a case report with brief review of literature. Indian J Anaesth 2011;55:629-30.
2Hobaika, AB. Breakage of epidural catheters: Etiology, prevention, and management. Rev Bras Anestesiol 2008;58:227-33.
3Nishio I, Sekiguchi M, Aoyama Y, Asano S, Ono A. Decreased tensile strength of an epidural catheter during its removal by grasping with a hemostat. Anesth Analg 2001;93:210-2.
4Demiraran Y, Yucel I, Erdogmus B. Subcutaneous effusion resulting from an epidural catheter fragment. Br J Anaesth 2006;96:508-9.
5Gadalla F. Removal of a tenacious epidural catheter. Anesth Analg 1992;75:1071-2.
6Jonglieux EF, Miller R, Freeman A. An entrapped epidural catheter in a postpartum patient. Reg Anesth Pain Med 1998;23:615-7.
7Asai T, Yamamoto K, Hirose T, Taguchi H, Shingu K. Breakage of epidural catheters: A comparison of an Arrow reinforced catheter and other nonreinforced catheters. Anesth Analg 2001;92:246-8.
8Browne RA, Politi VL. Knotting of an epidural catheter: A case report. Can Anaesth Soc J 1979;26:142-4.
9Shantha TR, Mani M. A simple method to retrieve irretrievable epidural catheters. Anesth Analg 1991;73:508-9.