Pitfalls of a Shared Neuraxial Space: Wandering Epidural Catheter, 
Rani A. Sunder, M.D.; Eric J. Monroe, M.D.; Sean H. Flack, M.B., Ch.B., F.C.A.
Anesthesiology Published online July 17, 2019. doi:10.1097/ALN.0000000000002900

Newly Published
Images in Anesthesiology  |   July 2019
Pitfalls of a Shared Neuraxial Space: Wandering Epidural Catheter
Rani A. Sunder, M.D.; Eric J. Monroe, M.D.; Sean H. Flack, M.B., Ch.B., F.C.A.
 Author Notes
From the Department of Anesthesiology and Pain Medicine (R.A.S., S.H.F.), and the Department of Interventional Radiology (E.J.M.), Seattle Childrens Hospital, Seattle, Washington.
Correspondence: Address correspondence to Dr. Sunder: rani.sunder@seattlechildrens.org
Anesthesiology Newly Published on July 17, 2019. doi:10.1097/ALN.0000000000002900

Children with severe spasticity with indwelling baclofen pumps often present for extensive orthopedic procedures to improve mobility and comfort. Procedural pain can be effectively managed by epidural infusions. Epidurals are sited at surgically congruent levels either above or below the level of insertion of the intrathecal catheter.1,2
The three-dimensional reconstructed view demonstrates the course of epidural catheter traveling caudally in the epidural space (image). The catheter travels from the L4 level coursing antero-laterally at the L5 level, “wandering” toward the left L5–S1 foramen to lie anterior to the sacrum.
The epidural catheter is placed in the L4–L5 interspace with the bevel of the Touhy needle directed cephalad in a patient with a longstanding intrathecal catheter at the L3 level.