減痛分娩硬脊膜外導管置入後打結案例與文獻回顧

Epidural Catheter Knotting after Epidural Labor Analgesia-A Case Report and Review

在執行減痛分娩技術時，硬脊膜外導管打結是相當罕見的併發症。此篇回顧一位產婦在生產後，硬脊膜外導管打結且難以移除的案例。在一開始拉扯導管時，產婦合併疼痛情形；經過幾次嘗試並變換產婦姿勢，導管終於順利移除。根據文獻回顧，過深或過長的硬脊膜外導管置入，尤其在硬脊膜外腔內長度超過５公分的時候，會增加導管纏繞、彎曲或扭轉的風險。在此併發症發生時，可透過目前文獻建議的方式去移除導管，並持續觀察相關神經學症狀。

Epidural catheter knotting is a very rare complication for epidural analgesia. We reported a woman with epidural catheter knotting for labor analgesia. The epidural catheter was stuck while removing and concomitant with painful sensation. We failed to pull out the catheter during the initial attempt. After several attempts and changing the patient's position, we removed the catheter successfully and then found the knotting catheter. Literature review suggested too much insertion distance increasing the risks for epidural catheter coiling, bending or twisting and recommend that epidural catheter is better not inserted more than 5cm into the lumbar epidural space. There are also some recommended strategies to remove the catheter. The associated neurological symptoms should also be closely observed when epidural catheter knotting happened.