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Epidural Abscess Complicating Tunneled Caudal Epidural Catheter in an Infant for Postoperative Pain Management of

Amr Elhamrawy1, Savannah Aepli1, Grant Heydinger1,2

  • 1Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.

Journal of Medical Cases
|February 8, 2024
PubMed

Insights

A rare epidural abscess occurred in an infant after caudal epidural catheter use for pain management. Prompt diagnosis via MRI and treatment with antibiotics and surgery led to a full recovery.

Area of Science:

  • Pediatric Anesthesia
  • Neurosurgery
  • Infectious Diseases

Background:

  • Regional anesthesia, including epidural techniques, is increasingly used in pediatric patients.
  • Potential adverse effects exist, such as infection, even with standard care during epidural catheter placement and use.
  • This case highlights a rare complication in infant pain management.

Observation:

  • A 4-month-old infant developed an epidural abscess postoperatively after receiving a tunneled caudal epidural catheter for abdominal surgery pain.
  • Magnetic resonance imaging (MRI) confirmed the epidural abscess.
  • The infant presented with no neurological deficits prior to diagnosis.

Findings:

  • Management involved intravenous antibiotics and hemilaminectomy with abscess and hematoma evacuation.
  • The infant recovered well with no neurological deficits post-treatment.
  • Prompt removal of the epidural catheter and cultures are crucial if infection is suspected.

Implications:

  • This case underscores the importance of vigilance for rare complications like epidural abscesses in infants receiving regional anesthesia.
  • Early diagnosis and multidisciplinary management involving neurosurgery and infectious diseases are vital for favorable outcomes.
  • Standard care protocols should emphasize immediate catheter removal and diagnostic workup upon suspicion of infection.

Keywords:
Caudal blockEpidural abscessEpidural anesthesiaInfection

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