Khan Sanaa, Nazir Ahmed Wajahat, Aleem Asad, Ur Rehman Saad
Anesthesia, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK.
Cureus. 2023 Apr 16;15(4):e37642. doi: 10.7759/cureus.37642. eCollection 2023 Apr.
Thoracic epidural placement is considered the gold standard for pain management for abdominal or thoracic surgery. It provides analgesia superior to that provided by opioids with a decreased risk of pulmonary complications. Insertion of a thoracic epidural catheter requires the knowledge and expertise of an anesthetist; epidural catheter insertion may be challenging especially when sited in the higher thoracic region, in patients with unusual neuraxial anatomy, patients unable to position adequately for insertion or morbidly obese patients.Postoperatively the anesthetic team is required to look after the patient and assess for any complications such as hypotension. Even though the incidence of complications may be low; however, some of these could have detrimental consequences for the patients such as epidural abscess, hematoma formation, and temporary or permanent neurological damage. In this case report, we will discuss a patient who underwent a three-stage esophagectomy for esophageal squamous cell carcinoma under general anesthesia with epidural analgesia. The epidural catheter (Portex® Epidural Minipack System with NRFit® connector, ICUmedical, USA) was found in the intrapleural space during video-assisted thoracoscopy for the thoracic part of esophagectomy. To facilitate surgical access, the catheter was removed immediately, and the patient was given patient-controlled analgesia with morphine for postoperative pain control.
胸段硬膜外置管被认为是腹部或胸部手术疼痛管理的金标准。它提供的镇痛效果优于阿片类药物，且肺部并发症风险降低。插入胸段硬膜外导管需要麻醉医生具备相关知识和专业技能；硬膜外导管插入可能具有挑战性，尤其是在胸段较高部位、神经轴解剖结构异常的患者、无法为插入做好充分体位准备的患者或病态肥胖患者中。术后，麻醉团队需要照顾患者并评估是否有任何并发症，如低血压。尽管并发症的发生率可能较低；然而，其中一些可能会对患者产生有害后果，如硬膜外脓肿、血肿形成以及暂时或永久性神经损伤。在本病例报告中，我们将讨论一名在全身麻醉联合硬膜外镇痛下接受三阶段食管鳞状细胞癌食管切除术的患者。在食管切除术胸段部分的电视辅助胸腔镜检查期间，发现硬膜外导管（带有NRFit®连接器的Portex®硬膜外迷你包系统，美国ICUmedical公司）位于胸膜腔内。为便于手术操作，立即移除了导管，并给予患者吗啡自控镇痛以控制术后疼痛。
