Retained Fractured Epidural Catheters: A Case Series and a Proposed Management Algorithm

Abstract

Retained fractured epidural catheter fragments are a rare but potentially serious complication of neuraxial anaesthesia, with reported incidences ranging from 0.002% to 0.055%. Despite their infrequency, management remains controversial, particularly in asymptomatic patients, due to the balance between risks of surgical retrieval and potential long-term complications such as migration, infection, granuloma formation, and neurological compromise. Methods and Objective: This was a 2 -centre retrospective study of nine patients with retained epidural catheter fragments following lumbar epidural anaesthesia from 2023-2025. The objective of the study is to describe and evaluate the outcomes of treatment and to design a management guideline. Results: Computed tomography (CT) scan successfully localized the retained fragments in all cases, with fragment lengths ranging from 0.9 cm to 15 cm, and locations including intra-canal, interlaminar, and paraspinal regions. Seven patients underwent surgical removal within 2–5 days of the incident, while two were managed conservatively. Surgical outcomes were rather favorable. Conclusion: Our findings support CT scan as the primary imaging modality for accurate localization of retained catheter fragments. Clinical decisions should be guided by symptomatology, fragment location, length, and age factors. Based on expert consensus, we propose a structured management algorithm emphasizing early imaging, risk stratification, and shared decision-making. This approach aims to standardize care, reduce morbidity, and address medicolegal considerations in both tertiary and resource-limited settings.