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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Unintended intrapleural insertion of an epidural catheter in thoracic surgery: r...
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Vol. 69. Issue 9.
Pages 597-601 (November 2022)
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Vol. 69. Issue 9.
Pages 597-601 (November 2022)
Case report
Unintended intrapleural insertion of an epidural catheter in thoracic surgery: regional analgesia game over, or is there another way out?
Inserción intrapleural involuntaria de un catéter epidural en cirugía torácica: ¿está fuera de juego la analgesia regional o existe otra salida?
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C. Ribeiroa,
Corresponding author
carolinasbribeiro@gmail.com

Corresponding author.
, I. Castrob, S. Lopesc, G. Paupérioc
a Department of Anesthesiology, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
b Department of Anesthesiology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
c Thoracic Surgery, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
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Abstract

In thoracic surgery, optimized pain control is crucial to prevent dysfunction in cardiorespiratory mechanics. Epidural anesthesia (EA) and paravertebral block (PVB) are the most popular techniques for analgesia. Unintended intrapleural insertion of an epidural catheter is a rare complication.

Our report presents a case of a patient submitted to pulmonary tumor resection by video-assisted thoracoscopic surgery (VATS). There was difficulty in epidural insertion related to patient’s obesity, but after general anesthesia induction, no additional intravenous analgesia was needed after epidural injection. Surgery required conversion to thoracotomy, with intrapleural identification of epidural catheter. At the end of surgery, surgeons reoriented catheter to paravertebral space, with leak absence confirmation after local anesthetic injection through the catheter. In postoperative period, pain control was efficient, with no complications.

It was a successful case that shows that when we find unexpected complications, we can look for alternative solutions to give our patient the best treatment.

Keywords:
Thoracic epidural
Paravertebral block
Thoracotomy
Regional anesthesia
Anesthesia complications
Resumen

En cirugía torácica, el control optimizado del dolor es esencial para prevenir disfunciones de la mecánica cardiorrespiratoria. La anestesia epidural (AE) y el bloqueo paravertebral (PVB) son las técnicas analgésicas más populares. La inserción intrapleural involuntaria de un catéter epidural es una complicación infrecuente.

Nuestro informe presenta un caso de un paciente sometido a resección de tumor pulmonar mediante cirugía toracoscópica asistida por video (VATS). Existió dificultad para la inserción del catéter debido a la obesidad del paciente, pero tras la inducción de la anestesia no se necesitó analgesia intravenosa adicional tras la inyección epidural. Se requirió convertir la cirugía en toracotomía, con identificación intrapleural del catéter epidural. Al finalizar la cirugía los cirujanos reorientaron el catéter en el espacio paravertebral, con confirmación de ausencia de fuga tras la inyección de anestesia local a través del catéter. En el periodo postoperatorio el control del dolor fue eficaz y sin complicaciones.

Se trata de un caso exitoso que muestra que cuando encontramos complicaciones imprevistas podemos buscar soluciones alternativas para proporcionar a nuestro paciente el mejor tratamiento.

Palabras clave:
Epidural torácica
Bloqueo paravertebral
Toracotomía
Anestesia regional
Complicaciones de la anestesia

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