Knot formation in a thoracic epidural catheter: a case report.

BACKGROUND: Although most epidural catheter knot formation has been reported in lumbar epidural catheter placement, knot formation in a thoracic epidural catheter has been experienced.

CASE PRESENTATION: A 72-year-old woman was scheduled for laparoscopic cholecystectomy under general anesthesia combined with epidural anesthesia. The epidural catheter was inserted through the Th10-Th11 intervertebral space and was placed 7 cm into the epidural space. Two days after the surgery, the anesthesiologist was called because of difficulty in removing the epidural catheter. The catheter was eventually removed when the anesthesiologist carefully pulled it while strongly bending the patient's body to the right, although resistance was still noted. The removed catheter was observed to have a hard single knot formed at about 3 mm from the tip.

CONCLUSIONS: A knot formation of an epidural catheter placed at the thoracic level was experienced. Limiting the length of catheter placement may prevent knot formation.