Case 41: Intraoperative Epidural Catheter Malfunction

  • John G. Brock-Utne


A 62-year-old obese male (wt, 120 kg; ht., 190 cm; body mass index, 33.2 kg/m2), ASA 2, is scheduled for a colectomy secondary to ulcerative colitis. You plan a combined general anesthetic technique with an epidural. When the patient is in the operating room, you place an epidural catheter (20 G closed tip) (B. Braun Medical Inc., Bethlehem, PA 18018, USA) uneventfully in the L4–L5 interspace. The length of the epidural catheter in the epidural space is 4 cm. As is your practice, the epidural catheter, as it leaves the patient’s back, is led in a semicircle over a folded 2 × 2 inch swab. This is then covered with an OpSite (Flexigrid, Smith and Nephew, Hull HU3 2BN, England). The catheter is attached to the patient’s back and over his right shoulder using Compound Benzoin Tincture USP (The Clinipad Corporation, Guilford, CT 06437, USA) and tape (Hytape Surgical Produce Corporation, Yonkers, NY 10704, USA). There is a negative test to 3 ml of lidocaine 2% with epinephrine 1; 200,000. A total of 22 ml of lidocaine 2% is then injected and a block to T-4 is achieved. The patient is placed in a supine position and routine general anesthesia commenced. Further two additional boluses are injected into the epidural space with good effect and no problem. Forty minutes after the last dose, the surgeon requests that the patient be placed in a steep head-down position. Shortly thereafter, it becomes impossible to inject anything through the epidural catheter, despite the use of a small syringe. You suggest that the surgeon puts the table back in the original position, but he is unwilling to do so at that time. You are reluctant to abandon your epidural. Is there anything else you could do to get the epidural to function adequately again?


Epidural catheter Obesity General anesthesia Epidural Subcutaneous tissue 


  1. 1.
    Leith P, Sanborn R, Brock-Utne JG. Intraoperative epidural catheter malfunction in two obese patients. Acta Anaesthesiol Scand. 1997;41:651–3.CrossRefPubMedGoogle Scholar
  2. 2.
    Smith AJ, Eggers KA. Potential hazard with the epidural space catheterization. Anaesthesia. 1995;50:88–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Khalour FK, Kunkel FA, Freeman J. Stretching with obstruction of an epidural catheter. Anesth Analg. 1987;66:1202–3.CrossRefGoogle Scholar
  4. 4.
    Wildsmith JAW, Armitage EN. Principles and practice of regional anesthesia. 2nd ed. New York: Churchill Livingstone; 1993.Google Scholar
  5. 5.
    Nash TG, Openshaw DJ. Unusual complication of epidural anaesthesia. Br Med J. 1968;1:700.CrossRefGoogle Scholar
  6. 6.
    Gough JD, Johnston KR, Harmer M. Kinking of epidural catheters. Anaesthsia. 1986;4:1060.CrossRefGoogle Scholar
  7. 7.
    Kulkarni PK, Pai VA, Shah RP, Joshi SR. Intraluminal obstruction of epidural catheter due to manufacturing defect. J Anaesthesiol Clin Pharmacol. 2012;28(2):280.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Arnaoutoglou HM, Tzimas PG, Papadopoulos GS. Knotting of an epidural catheter: a rare complication. Acta Anaesthesiol Belg. 2007;58:55–7.PubMedGoogle Scholar
  9. 9.
    Macfarlane J, Paech MJ. Another knotted epidural catheter. Anaesth Intensive Care. 2002;30:240–3.PubMedGoogle Scholar
  10. 10.
    Tsai YS, Tseng CC, HP S, Che PCA. Rare case of epidural catheter luminal obstruction. Anaesth Intensive Care. 2010;38(2):394.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • John G. Brock-Utne
    • 1
  1. 1.Department of AnesthesiaStanford UniversityStanfordUSA

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