Breakage of a catheter in the epidural space

Breakage of epidural catheters during their removal is rare, but it has been described. The anesthesiologist should be aware of the complications and proper handling of those catheters. The objective of this report was to present a case of breakage of an epidural catheter in labor analgesia.

A 33-year old female, gravida II, I delivery, was admitted to the maternity ward in labor. After two hours, the patient requested analgesia. On physical exam, the patient was in labor, with cervical dilation of 5 cm, regular uterine dynamics, broken amniotic membrane, and pain of 10 by the Visual Analog Scale (VAS). Labor analgesia was instituted using combined double puncture technique. During labor evolution, one analgesia complementation through the catheter. Catheter removal was somewhat difficult, leading to breakage of the catheter. Axial CT and X-ray of the lumbar spine did not show the fragment of the catheter. Since the patient was asymptomatic, without signs of radicular irritation, pain, or infection, proper precautions were taken and the patient was discharged from the hospital.

Epidural catheters in the lumbar region are, occasionally, hard to remove. Factors that increase the chances of knot formation and the risk of breakage of catheters were listed. In the present case, one of the main factors was the excessive introduction of the epidural catheter. Luckily, neurologic complications are even less frequent, and applying gentle traction, in the absence of paresthesias, the catheter is usually successfully removed.