Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942008000300005
Brazilian Journal of Anesthesiology
Scientific Article

Quebra de cateteres peridurais: etiologia, prevenção e conduta

Breakage of epidural catheters: etiology, prevention, and management

Adriano Bechara de Souza Hobaika

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Resumo

JUSTIFICATIVA E OBJETIVOS: O objetivo desse estudo foi revisar os casos publicados de quebra de cateter peridural. Com as evidências coletadas na literatura, identificar os fatores que predispuseram a quebra e relacionar as condutas recomendadas para a prevenção e tratamento dessa complicação. MÉTODO: Foi realizada uma pesquisa do banco de dados da Pubmed, Embase e SciELO. RESULTADOS: Um total de 15 artigos foi identificado, relatando 30 casos de quebra de cateter peridural. Os casos foram avaliados quanto as informações referentes à cateterização e a retirada, além do tipo de cateter. Foram registradas as complicações provocadas pela presença dos fragmentos que ficaram retidos nos pacientes, além das indicações para a realização de laminectomia exploradora. Com as evidências obtidas na literatura, foram elaboradas recomendações referentes à profilaxia e ao tratamento dessa complicação. CONCLUSÕES: A introdução do cateter não deve ser feita mais do que 5 cm no espaço peridural. Deve-se proceder à laminectomia exploratória se o paciente apresentar sinais ou sintomas de alterações neurológicas, se o cateter estiver localizado dentro do espaço subaracnóideo ou quando a ponta quebrada do cateter estiver emergindo pela pele. Em decorrência da dificuldade em se localizar os fragmentos retidos com os exames de imagem disponíveis, os cateteres deveriam ser fabricados com materiais que facilitassem sua visualização.

Palavras-chave

COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: The objective of this study was to review published cases of breakage of epidural catheters and, with the data gathered in the literature, to identify predisposing factors for catheter breakage, and list the recommended conducts to prevent and treat this complication. METHODS: The search included the data banks of Pubmed, Embase, and SciELO. RESULTS: A total of fifteen studies reporting 30 cases of breakage of epidural catheters were identified. Information regarding the catheterization and removal of the catheter, besides the type of catheter, were analyzed for each case. Complications related to the presence of retained catheter fragments, as well as the indications for exploratory laminectomy, were recorded. With the evidence gathered from the literature, recommendations for prophylaxis and treatment of this complication were elaborated. CONCLUSIONS: The catheter should not be inserted more than five centimeters into de epidural space. Exploratory laminectomy should be undertaken if the patient develops signs or symptoms of neurologic changes, if the catheter is inside the subarachnoid space, or whenever the tip of the catheter is emerging out of the skin. Due to the difficulty to localize retained fragments by imaging exams, catheters should be manufactured with materials that improve their visualization.

Keywords

ANESTHETIC TECHNIQUES, Regional, COMPLICATIONS

References

Grewal S, Hocking G, Wildsmith JA. Epidural abscesses. Br J Anaesth. 2006;96:292-302.

Horlocker TT, Wedel DJ, Benzon H. Regional anesthesia in the anticoagulated patient: defining the risks (The Second ASRA Consensus Conference on Neuroaxial Anesthesia and Anticoagulation). Reg Anesth Pain Med. 2003;28:172-197.

Bonica JJ, Backup PH, Anderson CE. Peridural block: analysis of 3,637 cases and a review. Anesthesiology. 1957;18:723-784.

Tio TO, Macmurdo SD, McKenzie R. Mishap with an epidural catheter. Anesthesiology. 1979;50:260-262.

Moerman N, Porcelijn T, Deen L. A broken epidural catheter: Case report. Anaesthesist. 1980;29:17-18.

Crawford JS. Some maternal complications of epidural analgesia for labour. Anaesthesia. 1985;40:1219-1225.

Staats PS, Stinson MS, Lee RR. Lumbar stenosis complicating retained epidural catheter tip. Anesthesiology. 1995;83:1115-1118.

Blanchard N, Clabeau JJ, Ossart M. Radicular pain due to a retained fragment of epidural catheter. Anesthesiology. 1997;87:1567-1569.

Collier C. Epidural catheter breakage: a possible mechanism. Int J Obstet Anesth. 2000;9:87-93.

Asai T, Yamamoto K, Hirose T. Breakage of epidural catheters: A comparison of an Arrow reinforced catheter and other nonreinforced catheters. Anesth Analg. 2001;92:246-248.

Nishio I, Sekiguchi M, Aoyama Y. Decreased tensile strength of an epidural catheter during its removal by grasping with a hemostat. Anesth Analg. 2001;93:210-212.

Ubgoma S, Au-Truong X, Kranzler LI. The breaking of an intrathecally-placed epidural catheter during extraction. Anesth Analg. 2002;95:1087-1089.

Schummer W, Schummer C. Another cause of epidural catheter breakage?. Anesth Analg. 2002;94:233.

Dounas M, Peillon P, Lebonhomme JJ. Difficulties in the removal and rupture of a peridural catheter. Ann Fr Anesth Reanim. 2002;21:600-602.

Sah N, Finegold H. Breakage of epidural catheters in two parturients. Can J Anaesth. 2003;50:619-620.

Demiraran Y, Yucel I, Erdogmus B. Subcutaneous effusion resulting from an epidural catheter fragment. Br J Anaesth. 2006;96:508-509.

Gulcu N, Karaaslan K, Kandirali E. Detection of a retained epidural catheter fragment. Reg Anest Pain Med. 2006;31:589-590.

Boey SK, Carrie LE. Withdrawal forces during removal of lumbar extradural catheters. Br J Anaesth. 1994;73:833-835.

Gadalla F. Removal of a tenacious epidural catheter. Anesth Analg. 1992;75:1071-1072.

Jonglieux EF, Miller R, Freeman A. An entrapped epidural catheter in a postpartum patient. Reg Anesth Pain Med. 1998;23:615-617.

Browne RA, Politi VL. Knotting of an epidural catheter: a case report. Can Anaesth Soc J. 1979;26:142-144.

Shantha TR, Mani M. A simple method to retrieve irretrievable epidural catheters. Anesth Analg. 1991;73:508-509.

Ates Y, Yucesoy CA, Unlu MA. The mechanical properties of intact and traumatized epidural catheters. Anesth Analg. 2000;90:393-399.

Blass NH, Roberts RB, Wiley JK. The case of the errant epidural catheter. Anesthesiology. 1981;54:419-421.

Tsui BCH, Finucane B. Tensile strength of 19- and 20-gauge arrow epidural catheters. Anesth Analg. 2003;97:1524-1526.

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