Management of a broken epidural catheter: A personalized approach

A broken epidural catheter with a retained fragment in the spinal canal is a rare complication. We present the case of a 28-year-old female diagnosed with Mirizzi's syndrome—a rare condition where a gallstone is lodged in the neck of the gallbladder or cystic duct, leading to obstruction of the common bile duct—who underwent an open cholecystectomy under general anesthesia. For postoperative pain management, a thoracic epidural catheter was placed at the D8/D9 level. The loss-of-resistance-to-air technique was used for catheter placement. However, during repositioning, the catheter was inadvertently withdrawn while the Tuohy needle remained in place, resulting in the catheter shearing off and leaving a fragment retained in the epidural space. The fragment was successfully retrieved through surgical exploration. Although epidural anesthesia is generally safe, complications such as catheter breakage and fragment retention are rare but significant risks. In cases where a retained epidural catheter fragment is identified, immediate surgical retrieval by a qualified spine surgeon should be considered to minimize potential complications and ensure optimal patient outcomes.