Another Cause of Epidural Catheter Breakage?

To the Editor: We read with great interest the article by Nishio et al. (1) and we would like to add some experiences we had in a similar case. A 20-yr-old healthy parturient in active labor received an epidural catheter by loss-of-resistance-technique (Perifix® 300 Mini-Set G18 × 3 1/4). In a sitting position, a Tuohy needle was placed into the L3-4 epidural space, and the catheter was advanced 3 cm and secured by a suture at skin level (11 cm). No problems were reported. For catheter removal, the suture was cut with a surgical blade away from the catheter. Manual extraction was attempted but the catheter broke at 11 cm. Resonance imaging and computed tomography were performed, but both techniques failed to identify the catheter without doubt. As the patient remained without any sequelae, the catheter fragment was not removed (2). There was no obvious damage to the catheter, and the operators denied any damage to the catheter (e.g., withdrawal through the Tuohy needle, puncturing, cutting). However, we could not definitely exclude microlesions and it is possible that the suture itself may have caused the microlesions. Each kind of trauma deteriorates the energy-absorbing capacity of catheters considerably (3). Therefore, fixation by suturing should only be performed if there is a good indication for it. Wolfram Schummer, MD, DEAA, EDIC Claudia Schummer, MD