{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T10:14:52Z","timestamp":1783678492433,"version":"3.55.0"},"reference-count":17,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2025,8,7]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Thoracic epidural analgesia is widely considered the gold standard for perioperative pain control in thoracic surgery. Despite its benefits, placement is technically challenging and can result in rare complications such as catheter misplacement into the intrapleural space.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>This case report will discuss a female patient in her late 70s with scoliosis and obesity who underwent robotic-assisted video-assisted thoracoscopic surgery for a pulmonary mass. The thoracic epidural catheter placed preoperatively was later directly visualized in the intrapleural space during the procedure. The catheter was immediately removed with no complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Thoracic epidural placement can be challenging due to patient factors, such as positioning, age, body habitus, and spinal deformities, as well as the inherent anatomy of the thoracic spine.<\/jats:p>\n                    <jats:p>Inadvertent intrapleural catheter misplacement is likely an under-reported complication that can lead to pneumothorax, hemothorax, and inadequate pain control; however, some catheters left in place have successfully been used for analgesia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2025-107022","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:30:26Z","timestamp":1756315826000},"page":"829-831","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Inadvertent intrapleural placement of a thoracic epidural catheter identified during robotic-assisted video-assisted thoracoscopic surgery (VATS)"],"prefix":"10.1136","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8140-5373","authenticated-orcid":false,"given":"Neslida","family":"Kodra","sequence":"first","affiliation":[{"name":"Mount Sinai Medical Center of Florida, Miami Beach, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Sugarman","sequence":"additional","affiliation":[{"name":"Mount Sinai Medical Center of Florida, Miami Beach, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Garcia","sequence":"additional","affiliation":[{"name":"Mount Sinai Medical Center of Florida, Miami Beach, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Garcia","sequence":"additional","affiliation":[{"name":"Mount Sinai Medical Center of Florida, Miami Beach, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,27]]},"reference":[{"key":"2026071002301572000_51.7.829.1","doi-asserted-by":"crossref","DOI":"10.3390\/jpm13121672","article-title":"Post-Operative Thoracic Epidural Analgesia and Incidence of Major Complications according to Specific Safety Standardized Documentation: A Large Retrospective Dual Center Experience","volume":"13","author":"Sarridou","year":"2023","journal-title":"J Pers Med"},{"key":"2026071002301572000_51.7.829.2","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1007\/s40122-025-00712-y","article-title":"Bayesian Network Meta-Analysis of Postoperative Analgesic Techniques in Thoracoscopic Lung Resection Patients","volume":"14","author":"Yue","year":"2025","journal-title":"Pain Ther"},{"key":"2026071002301572000_51.7.829.3","doi-asserted-by":"crossref","unstructured":"Khan S , Nazir Ahmed W , Aleem A , et al . Inadvertent Placement of Thoracic Epidural Catheter in Pleural Cavity: A Case Report and Review of Published Literature. Cureus 2023. doi:10.7759\/cureus.37642","DOI":"10.7759\/cureus.37642"},{"key":"2026071002301572000_51.7.829.4","doi-asserted-by":"crossref","DOI":"10.5492\/wjccm.v13.i3.94157","article-title":"Why do thoracic epidurals fail? A literature review on thoracic epidural failure and catheter confirmation","volume":"13","author":"Kumar","year":"2024","journal-title":"World J Crit Care Med"},{"key":"2026071002301572000_51.7.829.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0952-8180(98)00038-5"},{"key":"2026071002301572000_51.7.829.6","doi-asserted-by":"crossref","first-page":"163","DOI":"10.4103\/0019-5049.79898","article-title":"Pleural puncture with thoracic epidural: A rare complication?","volume":"55","author":"Wadhwa","year":"2011","journal-title":"Indian J Anaesth"},{"key":"2026071002301572000_51.7.829.7","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S1875-4597(08)60022-3","article-title":"Intrapleural misplacement of a thoracic epidural catheter in an anesthetized patient","volume":"46","author":"Lin","year":"2008","journal-title":"Acta Anaesthesiol Taiwan"},{"key":"2026071002301572000_51.7.829.8","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1097\/00000542-198611000-00026","article-title":"Rare misplacements of epidural catheters","volume":"65","author":"Koch","year":"1986","journal-title":"Anesthesiology"},{"key":"2026071002301572000_51.7.829.9","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000255654.01482.74"},{"key":"2026071002301572000_51.7.829.10","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1111\/j.1365-2044.1998.00304.x","article-title":"Accidental pleural puncture by a thoracic epidural catheter","volume":"53","author":"Zaugg","year":"1998","journal-title":"Anaesthesia"},{"key":"2026071002301572000_51.7.829.11","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/BF03016297","article-title":"Intrathoracic positioning of a thoracic epidural catheter inserted via the median approach","volume":"52","author":"Patermann","year":"2005","journal-title":"Can J Anaesth"},{"key":"2026071002301572000_51.7.829.12","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1007\/s00540-004-0226-8","article-title":"Pneumothorax associated with epidural anesthesia","volume":"18","author":"Miura","year":"2004","journal-title":"J Anesth"},{"key":"2026071002301572000_51.7.829.13","doi-asserted-by":"publisher","DOI":"10.1016\/0952-8180(94)90093-0"},{"key":"2026071002301572000_51.7.829.14","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1213\/01.ANE.0000140241.97973.73","article-title":"Unintentional intrapleural insertion of an epidural catheter: should we remove it or leave it in situ to provide perioperative analgesia?","volume":"100","author":"Inoue","year":"2005","journal-title":"Anesth Analg"},{"key":"2026071002301572000_51.7.829.15","doi-asserted-by":"crossref","first-page":"121","DOI":"10.4103\/0259-1162.150188","article-title":"Epidural catheter misplaced into the thoracic cavity: Utilized to provide interpleural analgesia","volume":"9","author":"Sundary","year":"2015","journal-title":"Anesth Essays Res"},{"key":"2026071002301572000_51.7.829.16","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(03)01338-9"},{"key":"2026071002301572000_51.7.829.17","doi-asserted-by":"crossref","first-page":"62","DOI":"10.4103\/1658-354X.197345","article-title":"Preprocedural ultrasound examination versus manual palpation for thoracic epidural catheter insertion","volume":"11","author":"Hasanin","year":"2017","journal-title":"Saudi J Anaesth"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2025-107022","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T09:30:28Z","timestamp":1783675828000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2025-107022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,27]]},"references-count":17,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,6]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/rapm-2025-107022"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2025-107022","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"value":"1098-7339","type":"print"},{"value":"1532-8651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,27]]}}}