Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2024; 12(10): 1824-1829
Published online Apr 6, 2024. doi: 10.12998/wjcc.v12.i10.1824
Unique method for removal of knotted lumbar epidural catheter: A case report
Nian-Hua Deng, Xiao-Cong Chen, Shou-Bo Quan
Nian-Hua Deng, Xiao-Cong Chen, Shou-Bo Quan, Anesthesia and Surgery Center, Dongguan Songshan Lake Central Hospital, Dongguan 523326, Guangdong Province, China
Author contributions: Deng NH and Chen XC contributed equally to this work; Deng NH and Chen XC wrote the manuscript; Quan SB was responsible for revision and quality supervision of the manuscript; all the authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Shou-Bo Quan, MD, Doctor, Professor, Teacher, Anesthesia and Surgery Center, Dongguan Songshan Lake Central Hospital, No. 1 Xianglong Road, Dongguan 523326, Guangdong Province, China.
Received: November 30, 2023
Peer-review started: November 30, 2023
First decision: January 29, 2024
Revised: February 3, 2024
Accepted: March 4, 2024
Article in press: March 4, 2024
Published online: April 6, 2024

Combined spinal-epidural (CSE) anesthesia is the preferred anesthesia method for cesarean delivery. The use of an epidural catheter is essential for administering additional drugs intraoperatively and managing postoperative pain. However, the insertion of epidural catheters is associated with various complications, such as total spinal anesthesia, symptoms indicative of spinal nerve root irritation, and challenges in epidural catheter removal.


We present a case report of a challenging epidural catheter removal due to knotting. The lumbar computed tomography scan results revealed that the catheter formed a tight knot in the epidural space. We used a novel extubation method and successfully removed the catheter.


The operator can use opposite forces to "spiral" apart the spinal joints by positioning the patient's body in a specific position. The findings indicate that, when combined with imaging examination results, this method is effective for the removal of epidural catheters.

Keywords: Epidural catheter, Knotting, Challenging extubation, Case report

Core Tip: Lumbar computed tomography imaging showed that the reinforced catheter formed a tight knot in the epidural space. The patient's body was placed in a specific position, and the doctor's hands were respectively at the right scapula and the right hip joint of the patient, and the force in the opposite direction was used to "spiral" the spinal joint, and the catheter was successfully removed.