title: Even a "pigtail" distal end catheter can enter the epidural space after continuous paravertebral block.
abstract: A woman with a medical history of breast cancer presented with chronic pain of the right hemithorax. To alleviate pain, a continuous paravertebral block was performed using a pigtail end catheter, introduced using ultrasound visualization (transversal technique at the inferior articular process of T6). Complete pain relief was observed. A few hours later, urinary retention was diagnosed and discharge from the ambulatory setting was canceled. On the following day, a new injection of local anesthetics through the catheter triggered paresthesia in the contralateral leg and a new urinary retention was diagnosed. A CT scan confirmed the epidural misplacement of the catheter. The latter was withdrawn, and the patient was released to home after the complete disappearance of her neurological symptoms. This case report highlights the risk of inadvertently misplacing the catheter into the epidural space during thoracic paravertebral block, even with a "pigtail" distal end type of catheter.
authors.affiliation: Department of Anesthesiology, Institut Claudius Regaud, University Institute of Cancer Toulouse Oncopole (IUCT-O), 1 Avenue Irène Joliot-Curie, 31059, Toulouse Cedex, France. fuzier.r@gmail.com.|Pharmacoepidemiology Research Unit, INSERM 1027, University of Toulouse, Toulouse, France. fuzier.r@gmail.com.
authors.forename: Régis
authors.identifier: 0000-0001-6298-7523
authors.initials: R
authors.lastname: Fuzier
authors.affiliation: Department of Anesthesiology, Institut Claudius Regaud, University Institute of Cancer Toulouse Oncopole (IUCT-O), 1 Avenue Irène Joliot-Curie, 31059, Toulouse Cedex, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Izard
authors.affiliation: Department of Radiology, Institut Claudius Regaud, IUCT-O, 31059, Toulouse, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Aziza
authors.affiliation: Department of Anesthesiology, Institut Claudius Regaud, University Institute of Cancer Toulouse Oncopole (IUCT-O), 1 Avenue Irène Joliot-Curie, 31059, Toulouse Cedex, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Pouymayou
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D057785:Catheters / Q000009:adverse effects*; D004824:Epidural Space; D005260:Female; D006801:Humans; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010146:Pain / Q000209:etiology; D010149:Postoperative Pain / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography / Q000009:adverse effects
chemical_list: D000779:Anesthetics, Local
keywords: Catheter; Epidural; Pain of cancer; Paravertebral block