Epidural Catheter Migration: A Case Report of a CT Scan Examination

Epidural catheter placement is one of the most effective, secure, and worldwide used pain control modalities. Epidural catheter dislodgment is a common cause of epidural block failure. The diagnosis of this situation is usually presumptive, and cases in which the actual trajectory and final location of the catheter are witnessed by imaging are rare. We present two cases of the insufficient epidural block due to catheter migration, confirmed by a CT scan with radiopaque contrast injection through the catheter. In the first case, the catheter tip was identified in the left major psoas muscle. Some catheter holes were probably located in a border zone between two compartments, which made the analgesic efficacy dependent on the infusion rate. In the second case, the catheter tip was identified as lodged in the left paravertebral space, which explains only unilateral left pain relief. In selected situations, like repeated ineffectiveness and in pretended long-duration catheters, imaging tests may be useful to determine the actual position of the catheter and identify anatomical variations that may lead to an incorrect replacement.