Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000100007
Brazilian Journal of Anesthesiology
Clinical Information

Cateter peridural deslocado: uma causa de falha de analgesia. Relato de caso

Displaced epidural catheter: a reason for analgesia failure. Case report

Sudbrack Guilherme; Karl Otto Geier

http://dx.doi.org/10.1590/S0034-70942002000100007 Braz J Anesthesiol, vol.52, n1, p.55-61, 2002
PDF Português
PDF English
Downloads: 0
Views: 916

Resumo

JUSTIFICATIVA E OBJETIVOS: A migração do cateter peridural é uma ocorrência rara. No entanto, quando não se obtém bloqueio condutivo após injeção de anestésico local através do mesmo, deve-se suspeitar de que ele não esteja no local esperado. O objetivo deste relato é descrever um caso de migração de cateter peridural (L3-L4) para o interior do músculo psoas maior direito, confirmado radiologicamente. RELATO DO CASO: Paciente feminina com 58 anos, portadora de tromboangeíte obliterante foi submetida à amputação do hálux esquerdo sob técnica combinada raqui-peridural. A punção subaracnóidea foi feita em L4-L5 e o cateter peridural foi passado em L3-L4 com o objetivo de fazer analgesia controlada pelo paciente (ACP), por via peridural, no pós-operatório. Como a ACP não apresentou resultados no pós-operatório, suspeitou-se de migração do cateter peridural que foi confirmada por estudo radiográfico contrastado. O cateter saiu pelo forâmen intervertebral e ficou alojado no músculo psoas maior direito. CONCLUSÕES: A ausência de efeitos após injeções repetidas de soluções analgésicas através de cateter peridural faz suspeitar que o mesmo não esteja no local apropriado. Estudo radiológico com contraste pôde confirmar o diagnóstico.

Palavras-chave

ANALGESIA, Pós-operatória, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Epidural catheter migration is a rare event. However, when post local anesthetic injection conductive blockade is not obtained it is to be suspected that the catheter is not in the desirable site. This report aimed at describing a case of epidural catheter migration (L3-L4) to the right greater psoas muscle, which was radiologically confirmed. CASE REPORT: Female patient, 58 years of age, with obliterating thromboangiitis, submitted to left hallux amputation under combined spinal-epidural anesthesia. Spinal puncture was performed at L4-L5 and the epidural catheter was inserted at L3-L4 aiming at postoperative patient-controlled epidural analgesia (PCA). Since there were no postoperative PCA results, there was a suspicion of epidural catheter migration, which was radiologically confirmed. The catheter crossed the intervertebral foramen and was lodged in the right greater psoas muscle. CONCLUSIONS: The absence of effects after repeated analgesic injections through the epidural catheter led to the suspicion that it was not properly placed. A radiological exam with contrast confirmed the diagnosis.

Keywords

ANALGESIA, Postoperative, COMPLICATIONS

Referencias

Hehre FW, Sying JM, Lowman RM. Etiologic aspects of failure of continuous lumbar peridural anesthesia. Anesth Analg. 1960;39:511-517.

Koch J, Nielsen JU. Rare misplacements of epidural catheters. Anesthesiology. 1986;65:556-557.

Bonica JJ. Pain Due Vascular Disease. The Management of Pain. 1990:502-537.

Bonica JJ, Cailliet R. Sympathetic Nerve Supply to Upper Limbs. The Management of Pain. 1990:833-837.

Bonica JJ. Sympathetic and Somatic Segmental and Peripheral Nerve Supply to the Hips And Lower Limbs. The Management of Pain. 1990:1421-1423.

Muller A, Sudbrack G. Sympatholyse par voie veineuse dans les artériopathies oblitérantes et dans les acrosyndromes. Agressologie. 1990;31:203-206.

Cousins MJ, Bromage PR. Epidural Neural Blockade. Neural Blockade. 1988:253-260.

Wee LH. Another cause for failed epidural. Anaesthesia. 1994;49:270-271.

Boezaart AP. Computerized axial tomo-epidurographic and radiographic documentation of unilateral epidural analgesia. Can J Anaesth. 1989;36:697-700.

Blanco D, Llmazares J, Rincón R. Thoracic epidural anesthesia via lumbar approach in infants and children. Anesthesiology. 1996;84:1312-1316.

Boesenberg AT, Balnd BAR, Schulte-Steinberg O. Thoracic epidural anesthesia via caudal route in infants. Anesthesiology. 1988;69:265-269.

Rasch DK, Webster DE, Pollard TG. Lumbar and thoracic epidural analgesia via the caudal approach for postoperative pain relief in infants and children. Can J Anaesth. 1990;37:359-362.

Chayen D, Nathan H, Chayen M. The paoas compartment block. Anesthesiology. 1976;45:95-99.

Ben-David B, Lee E, Croitoru M. Psoas block for surgical repair of hip fracture: a case report and description of a catheter technique. Anesth Analg. 1990;71:298-301.

Vaghadia H, Kapnoudhis P, Jenkins LC. Continuos lumbosacral block using a Thouhy needle and catheter technique. Can J Anaesth. 1992;39:75-78.

Parkinson SK, Mueller H, Little WL. Extent of blockades with various approaches to the lumbar plexus. Anesth Analg. 1989;68:243-248.

Hogan Q, Dotson R, Erikson S. Local anesthetic myotoxicity: A case and review. Anesthesiology. 1994;80:942-947.

Dunbar S. Migration of an epidural catheter related to flexion and extension of the spine. Anesth Analg. 1993;76:906.

Blouin RT, Ruby ST, Gross JB. Determination of intravascular migration of an epidural catheter using air technique. Anesthesiology. 1993;79:1427-1429.

Imbelloni LE. Possível cateterização subaracnóidea durante bloqueio combinado raqui-peridural com agulha de punção única: Relato de caso. Rev Bras Anestesiol. 1998;48:362-366.

Covino GB, Lambert DH. Epidural and Spinal Anesthesia. Clinical Anesthesia. 1989:755-786.

5dd59a420e8825a80cc8fca6 rba Articles
Links & Downloads
2352-2291 (Electrónico) 0104-0014 (Impreso)
Braz J Anesthesiol ©2024 Todos los derechos reservados.

Braz J Anesthesiol

Share this page
Page Sections