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Pleural puncture with thoracic epidural: A rare complication?

Wadhwa R, Sharma S, Poddar D, Sharma S - Indian J Anaesth (2011)

Bottom Line: Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery.There are case reports eliciting neurological complications, catheter site infections, paresthesias, radicular symptoms and worsening of previous neurological conditions.The patient had no sequelae on long term follow up even when a portion of catheter was retained.

View Article: PubMed Central - PubMed

Affiliation: PGIMER and Associated Dr. R M L Hospital, New, Delhi, India.

ABSTRACT
Freedom from pain has almost developed to be a fundamental human right. Providing pain relief via epidural catheters in thoracic and upper abdominal surgeries is widely accepted. Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery. But being a blind procedure it is accompanied by certain complications. Hypotension, dura puncture, high epidural, total spinal, epidural haematoma, spinal cord injury and infection are some of the documented side effects of epidural block. There are case reports eliciting neurological complications, catheter site infections, paresthesias, radicular symptoms and worsening of previous neurological conditions. Few technical problems related to breakage of epidural catheter are also mentioned in the literature. The patient had no sequelae on long term follow up even when a portion of catheter was retained. We present a case report where epidural catheter punctured pleura in a patient undergoing thoracotomy for carcinoma oesophagus.

No MeSH data available.


Related in: MedlinePlus

Blood in epidural catheter
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Figure 0004: Blood in epidural catheter

Mentions: Intraoperatively, epidural dose of bupivacaine 0.125% failed to cause decrease in heart rate and change in blood pressure. After 4 hours of laparotomy, thoracotomy was done on the right side. Repeated aspiration from epidural catheter during thoracotomy expressed frank blood, which continued even when catheter was withdrawn by 1 cm [Figure 4]. Epidural test dose was again repeated but it failed to show any changes in heart rate and electrocardiography. It was then suspected that epidural catheter might be misplaced and surgeons were asked to explore the epidural catheter, which was found lying in the right pleural cavity [Figure 5]. The epidural catheter was flushed with normal saline and removed very slowly. The tip of removed catheter was intact and the rest of the surgery was uneventful. Patient was transferred to intensive care unit for post-operative care and cardiopulmonary monitoring. He was discharged after 12 days from the Intensive Care Unit.


Pleural puncture with thoracic epidural: A rare complication?

Wadhwa R, Sharma S, Poddar D, Sharma S - Indian J Anaesth (2011)

Blood in epidural catheter
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3106390&req=5

Figure 0004: Blood in epidural catheter
Mentions: Intraoperatively, epidural dose of bupivacaine 0.125% failed to cause decrease in heart rate and change in blood pressure. After 4 hours of laparotomy, thoracotomy was done on the right side. Repeated aspiration from epidural catheter during thoracotomy expressed frank blood, which continued even when catheter was withdrawn by 1 cm [Figure 4]. Epidural test dose was again repeated but it failed to show any changes in heart rate and electrocardiography. It was then suspected that epidural catheter might be misplaced and surgeons were asked to explore the epidural catheter, which was found lying in the right pleural cavity [Figure 5]. The epidural catheter was flushed with normal saline and removed very slowly. The tip of removed catheter was intact and the rest of the surgery was uneventful. Patient was transferred to intensive care unit for post-operative care and cardiopulmonary monitoring. He was discharged after 12 days from the Intensive Care Unit.

Bottom Line: Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery.There are case reports eliciting neurological complications, catheter site infections, paresthesias, radicular symptoms and worsening of previous neurological conditions.The patient had no sequelae on long term follow up even when a portion of catheter was retained.

View Article: PubMed Central - PubMed

Affiliation: PGIMER and Associated Dr. R M L Hospital, New, Delhi, India.

ABSTRACT
Freedom from pain has almost developed to be a fundamental human right. Providing pain relief via epidural catheters in thoracic and upper abdominal surgeries is widely accepted. Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery. But being a blind procedure it is accompanied by certain complications. Hypotension, dura puncture, high epidural, total spinal, epidural haematoma, spinal cord injury and infection are some of the documented side effects of epidural block. There are case reports eliciting neurological complications, catheter site infections, paresthesias, radicular symptoms and worsening of previous neurological conditions. Few technical problems related to breakage of epidural catheter are also mentioned in the literature. The patient had no sequelae on long term follow up even when a portion of catheter was retained. We present a case report where epidural catheter punctured pleura in a patient undergoing thoracotomy for carcinoma oesophagus.

No MeSH data available.


Related in: MedlinePlus