Brazilian Journal of Anesthesiology
https://bjan-sba.org/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
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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

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