Inadvertent intrapleural placement of a thoracic epidural catheter identified during robotic-assisted video-assisted thoracoscopic surgery (VATS).

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

Regional Anesthesia and Pain Medicine Pub Date : 2025-08-27 DOI:10.1136/rapm-2025-107022

Neslida Kodra, Adam Sugarman, Alexis Garcia, Guillermo Garcia

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引用次数: 0

Abstract

Background: Thoracic epidural analgesia is widely considered the gold standard for perioperative pain control in thoracic surgery. Despite its benefits, placement is technically challenging and can result in rare complications such as catheter misplacement into the intrapleural space.

Case presentation: This case report will discuss a female patient in her late 70s with scoliosis and obesity who underwent robotic-assisted video-assisted thoracoscopic surgery for a pulmonary mass. The thoracic epidural catheter placed preoperatively was later directly visualized in the intrapleural space during the procedure. The catheter was immediately removed with no complications.

Conclusion: Thoracic epidural placement can be challenging due to patient factors, such as positioning, age, body habitus, and spinal deformities, as well as the inherent anatomy of the thoracic spine.Inadvertent intrapleural catheter misplacement is likely an under-reported complication that can lead to pneumothorax, hemothorax, and inadequate pain control; however, some catheters left in place have successfully been used for analgesia.

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在机器人辅助视频胸腔镜手术（VATS）中发现的胸膜内放置胸膜外导管。

背景：胸椎硬膜外镇痛被广泛认为是胸外科围手术期疼痛控制的金标准。尽管有诸多好处，但置入在技术上具有挑战性，并可能导致罕见的并发症，如导管误置入胸腔内腔。病例报告：本病例报告将讨论一位70多岁患有脊柱侧凸和肥胖的女性患者，她接受了机器人辅助视频辅助胸腔镜手术治疗肺部肿块。术前放置的胸廓硬膜外导管在手术过程中直接在胸膜内可见。导管立即取出，无并发症。结论：由于患者的体位、年龄、体质、脊柱畸形以及胸椎的固有解剖结构等因素，胸椎硬膜外置入可能具有挑战性。无意中胸膜内导管错位可能是一种未被报道的并发症，可导致气胸、血胸和疼痛控制不足；然而，一些留置导管已成功用于镇痛。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Regional Anesthesia and Pain Medicine 医学-麻醉学

CiteScore

8.50

自引率

11.80%

发文量

175

审稿时长

6-12 weeks

期刊介绍： Regional Anesthesia & Pain Medicine, the official publication of the American Society of Regional Anesthesia and Pain Medicine (ASRA), is a monthly journal that publishes peer-reviewed scientific and clinical studies to advance the understanding and clinical application of regional techniques for surgical anesthesia and postoperative analgesia. Coverage includes intraoperative regional techniques, perioperative pain, chronic pain, obstetric anesthesia, pediatric anesthesia, outcome studies, and complications. Published for over thirty years, this respected journal also serves as the official publication of the European Society of Regional Anaesthesia and Pain Therapy (ESRA), the Asian and Oceanic Society of Regional Anesthesia (AOSRA), the Latin American Society of Regional Anesthesia (LASRA), the African Society for Regional Anesthesia (AFSRA), and the Academy of Regional Anaesthesia of India (AORA).