Speakers - 2027

Title: Retained epidural catheter; A rare complication of regional anaesthesia successfully managed with immediate spine exploration

Abstract

This presentation discusses a rare but clinically significant complication of epidural anaesthesia—epidural catheter fracture leading to a retained epidural catheter—and highlights the importance of prompt recognition and management. Although epidural anaesthesia is widely regarded as safe and effective, complications such as catheter breakage can occur, most often due to shearing forces during withdrawal. In some cases, retained fragments may remain asymptomatic; however, concerns about fragment migration and potential neurological sequelae often necessitate timely intervention. We present the case of a 63-year-old male who underwent elective urethroplasty for a short segment bulbar urethral stricture. The patient had no significant comorbidities, and preoperative evaluation was unremarkable. Epidural anesthesia was chosen as the anaesthetic technique, with catheter insertion at the L4–L5 interspace. Difficulty encountered during drug administration raised suspicion of catheter kinking. During attempted removal, the catheter fractured, leaving a segment retained within the epidural space. Following intraoperative counselling and completion of the primary procedure, a multidisciplinary decision was made to proceed with early surgical intervention. The patient subsequently underwent laminectomy at the L5 level under general anaesthesia, with successful localization and retrieval of the retained fragment using fluoroscopic guidance. This case underscores key considerations in the management of retained epidural catheter fragments, including risk assessment, patient counselling, and the decision-making process between conservative versus surgical approaches. While non-operative management may be appropriate in selected asymptomatic cases, early spinal exploration offers definitive treatment and may reduce the risk of delayed complications, particularly in settings where surgical expertise and imaging support are readily available. Through this presentation, we aim to contribute to existing knowledge on retained epidural catheter management, emphasizing vigilance during catheter manipulation, awareness of risk factors for epidural catheter fracture, and the role of timely intervention. This case reinforces that, although rare, complications of epidural anesthesia require a structured and patient-centered approach to ensure optimal outcomes.