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Anesth Analg 2004;99:259-261
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000120082.85977.F7

REGIONAL ANESTHESIA

Inadvertent Cervical Epidural Catheter Placement via the Caudal Route Using Electrical Stimulation

Ban C. H. Tsui, MD MSc, FRCP(C), and Stephan Malherbe, MBChB MMed, FCA(SA)

Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, Edmonton, Alberta, Canada

Address correspondence and reprint requests to Ban C. H. Tsui, MD, MSc, FRCP(C), Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, 3B2.32 Walter Mackenzie Health Science Centre, 8440-112 St., Edmonton, Alberta, Canada T6G 2B7. Address e-mail to btsui{at}ualberta.ca

Inadvertent placement of an epidural catheter in the cervical region via the caudal route is described in an infant who underwent revision of a fundoplication. We attempted electrical stimulation (the Tsui test) via the epidural catheter to confirm correct placement and positioning of the catheter tip. In this case, the epidural catheter was inadvertently advanced to the cervical region, resulting in stimulation of the phrenic nerve. These diaphragmatic twitches were misinterpreted as chest wall twitches, and it was incorrectly assumed that the catheter was in the thoracic region. To avoid misinterpretation of the stimulation level, the catheter should be continuously stimulated while it is advanced. We also recommend that the catheter length be estimated before insertion (although doing so did not help in this case) and that the catheter position be radiographically confirmed after surgery.

IMPLICATIONS: To avoid misinterpretation of the stimulation level with the Tsui test, the epidural catheter should be continuously stimulated while it is advanced. The length of epidural catheter required should be predetermined before insertion, and the position of the catheter should also be radiographically confirmed after surgery.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2004 by the International Anesthesia Research Society.