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Canadian Journal of Anesthesia, Vol 39, 594-595, Copyright © 1992 by Canadian Anesthesiologists' Society

ARTICLES

Transforaminal escape of a lumbar epidural catheter

DG Halpenny, RG Loken and JA Williams
Department of Anaesthesia, Foothills Hospital, Calgary, Alberta.

A patient is presented whose lumbar epidural catheter was found to lie in the paravertebral tissues during a right radical nephrectomy. The catheter had been placed with the patient awake and the procedure performed in a routine fashion without difficulty or indication of catheter malposition. Four ml of 2% CO2 lidocaine were initially injected as a test dose without any demonstrable effect. After the induction of general anaesthesia, fentanyl 100 mu and 0.25% bupivacaine 10 ml were injected slowly into the catheter. Previous studies suggest that transforaminal escape of an epidural catheter occurs after 1-6% of insertions. It may occur without nerve root symptoms during catheter placement. The authors recommend that epidural catheters be introduced whilst the patients are awake and an effective block demonstrated before induction of general anaesthesia.




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Copyright © 1992 by the Canadian Anesthesiologists' Society.