Transforaminal migration of an epidural catheter

Excerpt

A 63-yr-old male patient (who consented to this report) was scheduled for reversal of an ileostomy that had been performed two years earlier after a right hemicolectomy for ischemia. His comorbidities included a prior heart transplant, renal failure, and numerous episodes of pneumonia. A multi-orificed epidural catheter (Perifix-Katheter; B. Braun Medical AG, Melsungen, Germany) was placed at the T10/11 level using a paramedian loss of resistance technique with an 80-mm 18G Tuohy needle (Perican Tuohy Nadel; B. Braun Medical AG, Melsungen, Germany).1 An epidural infusion (bupivacaine 2.5 mg·mL⁻¹ with fentanyl 4 μg mL⁻¹) was started after a test dose (3 mL lidocaine 1% with epinephrine 1:200 000), and general anesthesia was subsequently induced. The intraoperative course was uneventful. In the postanesthesia care unit, the epidural infusion was replaced by an opioid-free preparation (bupivacaine 2.5 mg·mL⁻¹) because of pruritus. Adjusted to a rate of 4 mL·hr⁻¹, it achieved a satisfactory sensory level of epidural analgesia at T10-L4. During hemodialysis on the first postoperative day, the patient developed weakness of the left quadriceps femoris muscle, whereupon the epidural application of bupivacaine was stopped. Subsequent computed tomography (CT) investigation of the spine revealed no spinal or epidural hematoma. The epidural catheter, however, appeared to have migrated through the left intervertebral foramen at the T10/11 level (Figure).

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