Serious Complications After Epidural Catheter Placement: Two Case Reports

Area of Science:

• Anesthesiology
• Neurosurgery
• Critical Care Medicine

Background:

• Thoracic epidural analgesia (TEA) is a cornerstone of multimodal pain management for major thoracic and abdominal surgeries.
• Effective pain control via TEA can significantly impact patient recovery and outcomes.

Observation:

• Two distinct cases highlight severe complications arising from TEA.
• Case 1: Epidural hematoma in a patient on anticoagulation post-lung resection, leading to paraplegia despite delayed intervention.
• Case 2: Catheter malposition during TEA for ulcerative colitis caused neurological compromise, including coma and respiratory arrest, upon accidental re-initiation of infusion.

Findings:

• Delayed diagnosis and intervention for epidural hematoma resulted in persistent paraplegia and sepsis.
• Misplaced epidural catheter and subsequent infusion restart led to acute neurological deterioration, reversible upon removal.
• Patient-reported sensory symptoms were critical indicators that were initially overlooked in both cases.

Implications:

• Emphasizes the critical need for vigilant monitoring and rapid response to patient-reported sensory changes during TEA.
• Highlights the importance of accurate catheter placement and careful management of anticoagulation in patients undergoing TEA.
• Suggests that earlier recognition of complications could significantly alter patient trajectories and prevent irreversible neurological damage.