Interpleural misplacement of an epidural catheter

We report a case of interpleural misplacement of an epidural catheter possibly caused by inappropriate angle of the Tuohy needle. A 71-year-old man was scheduled for left lower lobectomy of the lung with general and epidural anesthesia. A 18-gauge Tuohy needle was introduced into the Th5-Th6 interspace with a right paramedian approach. The direction of the epidural needle was at an angle of about 30 degrees from the skin directed cephalad. The needle was advanced 8 cm from the skin, where loss-of-resistance feeling was evident, and an epidural catheter was easily inserted 5 cm beyond the needle tip. Administration of 7 ml of 1.5% lidocaine given 20 minutes before skin incision did not alter arterial blood pressure or heart rate. Thoracotomy was performed via the fifth intercostal space. The surgeon then found the epidural catheter to be in the left pleural cavity. The catheter was immediately withdrawn. It is, therefore, necessary to employ the appropriate angle of the Tuohy needle on attempting epidural anesthesia to avoid the complication that we experienced.