Difficult Removal of an Epidural Catheter in the Anterior Epidural Space

When administering postoperative acute pain services, particularly regarding patient- controlled epidural analgesia, difficulties may occasionally be encountered during removal of the epidural catheter. In this report, we present an instance of difficult removal of epidural catheter in a female patient undergoing open reduction and internal fixation of the femoral neck with patient-controlled epidural analgesia as the means of postoperative pain control. The patient had satisfactory analgesia for 3 days; however, during the removal of the epidural catheter, difficulties were encountered and epidurogram revealed that the epidural catheter had become anchored in the anterior epidural space without kinking or knotting. Subsequently, the patient was requested to lie prone on the surgical table with a pillow placed beneath her lower abdomen and catheter removal was tried again. Fortunately, the epidural catheter was removed easily without the need for a guided stylet. We believe that the cause of the difficult removal of the epidural catheter in this case might have resulted from an unusual and unwanted deeper anchorage of the catheter along the anterior epidural space during placement. We also include some discussion on the management of problematic removal.