A knotty affair

Abstract

Continuous epidural anaesthesia through a catheter certainly offers the advantage of titrated, safe and prolonged anaesthesia along with a good quality of postoperative analgesia. Epidural catheters can cause some complications and one such rare complication is knotting in the epidural space. Epidural anaesthesia was planned for the arthroscopic repair of a torn anterior cruciate ligament. Intra operative and early postoperative periods were uneventful. However, the epidural catheter was found to be stuck when removal was attempted on the 4th postoperative day. Several attempts were made to retrieve the catheter by applying steady traction under maximal flexion of the back but failed. Finally, under spinal anaesthesia, the catheter was tracked, surgically, along its course up to the epidural space. A knot was observed at the tip of the retrieved catheter. There is a lot of debate in the literature favouring and contradicting the surgical removal of broken fragments of an epidural catheter. However, since the catheter was intact, we attempted removal by surgical dissection of the tract. Broken and lost fragments are better left untouched unless they pose problems and the patients reassured.