Migration of a Thoracic Epidural Catheter into the Intercostal Space via the Intervertebral Foramen

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We describe a documented migration of a thoracic epidural catheter into the thoracic cage in a 5-wk-old with DiGeorge's syndrome and an uncorrected acyanotic Tetralogy of Fallot who underwent laparotomy for malrotation, gastric fundoplication, and gastrostomy tube insertion under combined general and epidural anesthesia. A 20-gauge stimulating catheter was inserted caudally and advanced cephalad to the thoracic level while applying a low electrical current (1–10 mA) to confirm epidural placement at approximately T5–6. Despite good pain control through the third postoperative day, using an epidural infusion of bupivacaine 0.1% at 1–1.2 mL/h, radiography demonstrated catheter migration into the seventh intercostal space.

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