Baer Eriksson Lovisa, Borglund-Hemph Anna, Jakobsson Jan
Anestesi- och Intensivvårdskliniken, Danderyds sjukhus - Stockholm, Sweden Anestesi- och Intensivvårdskliniken, Danderyds sjukhus - Stockholm, Sweden.
Karolinska Institutet - Anaesthesia & Intensive Care Stockholm, Sweden Karolinska Institutet - Anaesthesia & Intensive Care Stockholm, Sweden.
Lakartidningen. 2017 Oct 23;114:ESEE.
Knot on the epidural catheter, a rare complication: a case report A 30-year 1-grava woman received an epidural for labor pain. Insertion was uncomplicated and she had an effective analgesia. The epidural was successfully converted to epidural anaesthesia for Caesarean section. The epidural was removed 24 hours thereafter. The mother was lying and trying to curve the back during removal. It was initially easy to pull but after some centimeters it became difficult. The mother was asked to curve further and pulling continued. The catheter came out with some constraints with a knot on the tip. The mother had no pain during traction. The subsequent course was uneventful. A knot on the epidural catheter is a rare complication to epidural analgesia/anaesthesia. There are several reviews giving advice how to avoid its occurrence and how to act if the catheter cannot be easily removed. It is advised to limit the length of catheter inserted into the epidural space; no more than 4-5 cm. If the catheter is not easily removed; »gentle and steady traction« is recommended with the patient initially in a position as similar as possible to the one during insertion. If it is still not possible to remove, an X-ray or MRI is suggested to confirm that there isn't any nerve involvement, followed by pulling firmly again until the catheter comes out or breaks. A broken catheter should »in general« be left in place unless symptoms occur.
一种罕见的并发症：病例报告 一名30岁初产妇因分娩疼痛接受硬膜外麻醉。穿刺过程顺利，她获得了有效的镇痛效果。硬膜外麻醉成功转换为剖宫产的硬膜外麻醉。此后24小时拔除硬膜外导管。拔管时产妇躺着并试图弓背。起初很容易拔出，但拔出几厘米后就变得困难了。要求产妇进一步弓背并继续拔管。导管拔出时受到一些阻力，尖端有一个结。拔管过程中产妇没有疼痛。随后的过程顺利。硬膜外导管打结是硬膜外镇痛/麻醉的一种罕见并发症。有几篇综述给出了如何避免其发生以及如果导管不易拔出该如何处理的建议。建议限制插入硬膜外腔的导管长度；不超过4 - 5厘米。如果导管不易拔出，建议在患者最初处于与穿刺时尽可能相似的体位时进行“轻柔且稳定的牵引”。如果仍然无法拔出，建议进行X线或磁共振成像检查以确认没有神经受累，然后再次用力牵拉直至导管拔出或折断。一般情况下，除非出现症状，折断的导管应留在原位。
