Epidural anaesthesia provides effective analgesia both intra- and postoperatively for lower limb surgeries. However, like any other procedure, it has also got unique complications. Shearing and breaking of the epidural catheter are one such complication whose subsequent management lacks uniformity. Given that the retained catheter fragment is not typically associated with a foreign body reaction, it is commonly seen that it is left in place in the majority of cases. Herein, we describe a case of long broken and retained epidural catheter segment (approximately 8 cm) which was removed through a surgical approach.

A 39-year-old male, American Society of Anesthesiology physical status I, was posted for surgery for non-union of right tibia under neuraxial anaesthesia (combined spinal-epidural) after thorough preoperative evaluation. Epidural catheter placement was carried out with the patient in sitting position at L2–3 intervertebral space, using midline approach with 18-G Tuohy’s needle under all aseptic precautions. Loss of resistance was perceived (needle depth 6 cm), following which the catheter was threaded into the epidural needle. However, there was difficulty in threading the desired length of the catheter. Therefore, it was speculated that the needle was not in the epidural space. Hence, the decision was taken to remove the catheter, but as the catheter was being pulled off along with the needle (as a single unit), it broke with approximately 8 cm of fragment retained in the patient’s back. The surgeon, the patient, and his relatives were informed immediately, and they were counselled about further management options and plans. After thorough discussion, it was decided to remove the broken fragment surgically as the patient and relatives wanted a definitive treatment owing to their inability to come for regular follow-up. Written informed consent was taken, and surgery was planned in prone position under general anaesthesia. C-arm (fluoroscopy) was used to localize the broken fragment. The thin catheter being deep down into the tissues of a muscular, well-built patient further compounded the problem of its localization even with radio-diagnostics.

The interspinous area at L2–3 was surgically exposed; the broken part was found to be present between the L2 and L3 interspinous space, and it was found heading into the paraspinous space (Fig. 1). Fortunately, the spinal duramater was found intact. The fragment was successfully retrieved at the first attempt by simple traction, and there was no cerebral spinal fluid leak post catheter removal (Fig. 2). Following a 1-month interval, the patient remained devoid of any discernible medical concerns.

Surgical removal of epidural catheter from paraspinous area

Retrieved broken epidural catheter