title: Migration of a thoracic epidural catheter into the intercostal space via the intervertebral foramen.
abstract: We describe a documented migration of a thoracic epidural catheter into the thoracic cage in a 5-wk-old with DiGeorge's syndrome and an uncorrected acyanotic Tetralogy of Fallot who underwent laparotomy for malrotation, gastric fundoplication, and gastrostomy tube insertion under combined general and epidural anesthesia. A 20-gauge stimulating catheter was inserted caudally and advanced cephalad to the thoracic level while applying a low electrical current (1-10 mA) to confirm epidural placement at approximately T5-6. Despite good pain control through the third postoperative day, using an epidural infusion of bupivacaine 0.1% at 1-1.2 mL/h, radiography demonstrated catheter migration into the seventh intercostal space.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Edmonton, Alberta, Canada. btsui@ualberta.c
authors.forename: Ban C H
authors.initials: BC
authors.lastname: Tsui
authors.forename: Pradeep
authors.initials: P
authors.lastname: Kulkarni
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery*; D015360:Analgesia, Epidural / Q000009:adverse effects* / Q000295:instrumentation; D000767:Anesthesia, Epidural / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling; D004062:DiGeorge Syndrome / Q000150:complications / Q000601:surgery; D004558:Electric Stimulation; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology*; D018662:Fundoplication; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D007441:Intubation, Gastrointestinal; D007813:Laparotomy; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D011859:Radiography; D013771:Tetralogy of Fallot / Q000150:complications / Q000601:surgery; D013904:Thoracic Vertebrae