Sbardelotto Cristian, Yoshimi Mauro Matsumoto, Pereira Raquel da Rocha, de Castro Renato Almeida Couto
CET, SBA, Serviço de Anestesiologia de Joinville, SC.
Rev Bras Anestesiol. 2008 Nov-Dec;58(6):643-50. doi: 10.1590/s0034-70942008000600009.
Breakage of epidural catheters during their removal is rare, but it has been described. The anesthesiologist should be aware of the complications and proper handling of those catheters. The objective of this report was to present a case of breakage of an epidural catheter in labor analgesia.
A 33-year old female, gravida II, I delivery, was admitted to the maternity ward in labor. After two hours, the patient requested analgesia. On physical exam, the patient was in labor, with cervical dilation of 5 cm, regular uterine dynamics, broken amniotic membrane, and pain of 10 by the Visual Analog Scale (VAS). Labor analgesia was instituted using combined double puncture technique. During labor evolution, one analgesia complementation through the catheter. Catheter removal was somewhat difficult, leading to breakage of the catheter. Axial CT and X-ray of the lumbar spine did not show the fragment of the catheter. Since the patient was asymptomatic, without signs of radicular irritation, pain, or infection, proper precautions were taken and the patient was discharged from the hospital.
Epidural catheters in the lumbar region are, occasionally, hard to remove. Factors that increase the chances of knot formation and the risk of breakage of catheters were listed. In the present case, one of the main factors was the excessive introduction of the epidural catheter. Luckily, neurologic complications are even less frequent, and applying gentle traction, in the absence of paresthesias, the catheter is usually successfully removed.
硬膜外导管在拔除过程中发生断裂的情况较为罕见，但已有相关报道。麻醉医生应了解这些导管的并发症及正确处理方法。本报告的目的是呈现一例分娩镇痛时硬膜外导管断裂的病例。
一名33岁女性，孕2产1，因临产入院至产科病房。两小时后，患者要求镇痛。体格检查时，患者处于产程中，宫颈扩张5厘米，子宫收缩规律，胎膜已破，视觉模拟评分（VAS）为10分。采用联合双穿刺技术实施分娩镇痛。在产程进展过程中，通过导管进行了一次镇痛补充。导管拔除有些困难，导致导管断裂。腰椎的轴向CT和X线检查未显示导管碎片。由于患者无症状，无神经根刺激、疼痛或感染迹象，采取了适当的预防措施后患者出院。
腰椎区域的硬膜外导管有时难以拔除。列出了增加导管打结几率和断裂风险的因素。在本病例中，主要因素之一是硬膜外导管置入过多。幸运的是，神经并发症更为少见，在无感觉异常的情况下轻柔牵拉，导管通常能成功拔除。
