UNINTENTIONAL PLEURAL PUNCTURE AFTER THORACIC EPIDURAL - A CASE REORT

Thoracic epidural analgesia is one of the most effective and time tested modalities of providing effective post-thoracotomy pain relief. It also reduces postoperative pulmonary complications like atelectasis, impaired coughing, retention of secretions, infections etc. Nevertheless, being a blind procedure several complications have been associated with the technique. Pleural puncture is one rare complication that might occur following thoracic epidural catheterisation. This case report is about a 55yr old male who underwent thoracotomy for excision of right lung emphysematous bulla under general anaesthesia with thoracic epidural block. During surgery the catheter tip was found to be in the right pleural cavity. There was no evidence of bleeding or lung injury around the puncture site. The catheter was left in situ and was utilised to provide post operative intrapleural analgesia with local anaesthetic. We have discussed probable reasons for pleural puncture during epidural blockade and certain precautions which could possibly prevent technique related complications.