Management of a Retained Epidural Catheter Fragment of Indeterminate Location: A Case Report

Abstract

Neuraxial anesthesia is widely used in obstetric practice due to its well-established benefits for both maternal and fetal outcomes. While spinal anesthesia is more commonly employed, epidural anesthesia remains a valuable alternative, especially when prolonged surgical duration is anticipated. Complications from epidural anesthesia are uncommon, with catheter fracture representing an exceedingly rare occurrence. Because of its rarity, this complication presents unique diagnostic and management challenges. This report details the case of a retained epidural catheter fragment in a parturient undergoing elective repeat cesarean section. During epidural placement, an inadvertent dural puncture occurred, followed by difficulty threading the catheter. Upon withdrawal, the catheter tip was found to be missing, prompting abandonment of the epidural technique and conversion to spinal anesthesia. Postoperatively, serial neurologic examinations revealed no deficits or signs of infection. Magnetic resonance imaging and ultrasound failed to localize the retained fragment, leading to a decision for conservative management. This report emphasizes comprehensive clinical and imaging evaluations in determining the suitable approach to a retained epidural catheter fragment. When a patient is asymptomatic with no radiologic evidence of a neuraxial fragment, observation with close follow-up is acceptable. On the other hand, when a patient develops symptoms or there is evidence of fragment retention within the spinal canal, surgical exploration may be necessary. Due to the risk for complications in the future, full disclosure, thorough documentation, and long-term monitoring are indispensable.