| Case Report | Korean J Pain 2011 March; Vol. 24, No. 1: 44-47 pISSN 2005-9159 eISSN 2093-0569 DOI：10.3344/kjp.2011.24.1.44 Epidural Catheter Malposition in a Failed Epidural Anesthesia Confirmed by Computed Tomography Department of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University, Seoul, Korea Se Jin Lee, MD, Sang Ho Kim, MD, Sun Young Park, MD, Mun Gyu Kim, MD, Bo Il Jung, MD, and Si Young Ok, MD We report a case of failed epidural anesthesia despite successful identification of the epidural space, loss of resistance technique, hanging drop method and drip infusion. This case evaluated the use of computed tomography to confirm epidural catheter position, which showed the catheter accidentally positioned at the T2 lamina. Because epidural anesthesia can even after successful procedure using standardized techniques such as loss of resistance, we recommend performing the procedure under fluoroscopic guidance to improve success rate and patient safety. (Korean J Pain 2011; 24: 44-47) Key Words: catheter malposition, epidural anesthesia, epidural space. Methods to identify the epidural space in epidural punc- verify the location of the epidural catheter; the result ture include loss of resistance technique to air or normal showed that the catheter had failed to penetrate through saline, hanging drop method [1], ultrasound-guided method the ligamentum flavum and had been positioned in the T2 [2-4], pressure-guided method [5], drip infusion method lamina erecter spinae muscle. [6,7], Queckenstedt test method [8], and use of acoustic device [9], or nerve stimulator [10]. Among these, loss of resistance technique is used most frequently. In this re- port, epidural anesthesia failed while performing high level CASE REPORT The 67-year old, male patient (164 cm, 70 kg) with thoracic epidural anesthesia for arteriovenous bridge graft chronic renal failure was supposed to undergo arterio- of the upper arm in a chronic renal failure patient even venous bridge graft of the upper arm for hemodialysis un- though loss of resistance technique, hanging drop method, der high level thoracic epidural anesthesia. Patient history and drip infusion method were all successful. revealed that he underwent coronary bypass graft six years We report a case in which an epidurogram and cervical ago and was taking antihypertensive agents and insulin for and thoracic computed tomography were performed to hypertension and diabetes. Blood tests performed after Received January 20, 2011. Revised January 27, 2011. Accepted January 27, 2011. Correspondence to: Sang Ho Kim, MD Department of Anesthesiology and Pain Medicine, College of Medicine, Soonchunhyang University, 22, Daesagwan-gil, Yongsan-gu, Seoul 140-743, Korea Tel: ＋82-2-709-9114, Fax: ＋82-2-790-0394, E-mail: pc@schmc.ac.kr This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright ⓒ The Korean Pain Society, 2011