{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T09:06:42Z","timestamp":1779700002844,"version":"3.53.1"},"reference-count":16,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Thoracic paravertebral catheters are increasingly used in neonates to avoid neuraxial techniques during thoracoscopic tracheoesophageal fistula (TEF) repair. Catheter fracture and retention are exceedingly rare in this population, and optimal management remains undefined. Learning Objectives: Recognize this complication risk in neonatal paravertebral placement; identify appropriate imaging when retention is suspected; discuss conservative and surgical approaches; and understand the importance of early transparent communication with caregivers. Case: A 2-day-old term neonate weighing 2.90 kg underwent thoracoscopic repair of type C tracheoesophageal fistula with intraoperative placement of an ultrasound-guided right paravertebral catheter for continuous analgesia. The catheter was placed at the T5 vertebral level using a 20 G, 2-inch Tuohy needle with an in-plane lateral-to-medial approach. Saline hydrodissection was used to confirm entry into the paravertebral space. A 24 G radiopaque Perifix One catheter was initially inserted but proved difficult to advance. During attempted removal, some resistance was encountered, and both the needle and catheter were withdrawn together. Subsequent inspection suggested possible catheter shortening, raising concern for a retained fragment. A second catheter of size 20 G advanced via an 18 G needle was then successfully placed at the same level and was removed without complications on postoperative day 3. Comparison with an intact reference catheter revealed that the first-placed 24 G catheter was approximately 1.5 cm shorter, although the tip appeared intact. The pain physician promptly notified both the clinical teams and the family. One month later, during routine imaging for respiratory distress, a curvilinear opacity was noted at the T9 vertebral level. Dedicated thoracic spine films confirmed a 7 mm retained paravertebral catheter fragment. Multidisciplinary consensus (pain team, anesthesia, NICU, and surgery) determined that the fragment was small, non-metallic, and remote from critical structures. Conservative management with long-term follow-up was chosen. The family was informed early during initial suspicion and again upon confirmation. At 17-month follow-up, the child remained asymptomatic. Discussion: Retained catheter fragments are rare in pediatric regional anesthesia and may be radiographically occult early. In neonates, re-operation for a tiny, inert foreign body may cause more morbidity than observation. Prevention depends on appropriate equipment selection, catheter integrity checks pre- and post-placement, careful technique, and attention to resistance or difficulty during advancement or removal. Clear and timely communication with caregivers preserves trust when complications or iatrogenic uncertainty arise. Conclusions: In this neonate, a small retained paravertebral catheter fragment was identified incidentally and was safely managed with conservative observation. When such fragments are non-metallic, stable, and located away from critical structures, non-operative management with close follow-up may be an appropriate and safe approach.<\/jats:p>","DOI":"10.3390\/children13060733","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T08:06:26Z","timestamp":1779696386000},"page":"733","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Retained Catheter Fragment After Continuous Paravertebral Block Placement for Thoracoscopic Repair of Tracheoesophageal Fistula of a Neonate: A Case Report"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2449-5146","authenticated-orcid":false,"given":"Roshni","family":"Cheema","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Children\u2019s Hospital of Pittsburgh, 4401 Penn Ave., Pittsburgh, PA 15224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0933-4536","authenticated-orcid":false,"given":"Mihaela","family":"Visoiu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Children\u2019s Hospital of Pittsburgh, 4401 Penn Ave., Pittsburgh, PA 15224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"151203","DOI":"10.1016\/j.sempedsurg.2022.151203","article-title":"Evolving approaches in neonatal postoperative pain management","volume":"31","author":"Visoiu","year":"2022","journal-title":"Semin. Pediatr. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1213\/ANE.0000000000001576","article-title":"Thoracic paravertebral nerve blocks in pediatric patients: Safety and clinical experience","volume":"123","author":"Vecchione","year":"2016","journal-title":"Anesth. Analg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1093\/bja\/aew387","article-title":"Paravertebral block in paediatric abdominal surgery- A systematic review and meta-analysis of randomized trials","volume":"118","author":"Page","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/s40272-019-00360-8","article-title":"A Review of Regional Anesthesia in Infants","volume":"21","author":"Boretsky","year":"2019","journal-title":"Pediatr. Drugs"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1111\/anae.15283","article-title":"Fundamentals and innovations in regional anaesthesia for infants and children","volume":"76","author":"Heydinger","year":"2021","journal-title":"Anaesthesia"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1111\/pan.13104","article-title":"Comparison of caudal ropivacaine-morphine and paravertebral catheter for major upper abdominal surgery in infants","volume":"27","author":"Sato","year":"2017","journal-title":"Paediatr. Anaesth."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/pan.14042","article-title":"Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations","volume":"31","author":"Relland","year":"2021","journal-title":"Paediatr. Anaesth."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1001\/jamasurg.2025.1899","article-title":"Intercostal or Paravertebral Block vs Thoracic Epidural in Lung Surgery: A Randomized Noninferiority Trial","volume":"160","author":"Spaans","year":"2025","journal-title":"JAMA Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1016\/j.jclinane.2015.05.002","article-title":"Ultrasound-guided thoracic paravertebral block catheter experience in 2 neonates","volume":"27","author":"Thompson","year":"2015","journal-title":"J. Clin. Anesth."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jclinane.2018.06.041","article-title":"Postoperative pain management for tracheoesophageal fistula repair using transverse, in-plane, ultrasound guided paravertebral technique in a 2 kg neonate","volume":"50","author":"Hernandez","year":"2018","journal-title":"J. Clin. Anesth."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1111\/aas.12372","article-title":"The use of ultrasound-guided regional anaesthetic techniques in neonates and young infants","volume":"58","author":"Marhofer","year":"2014","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"110361","DOI":"10.1016\/j.jclinane.2021.110361","article-title":"Management of a broken thoracic paravertebral catheter in a pediatric patient","volume":"73","author":"Visoiu","year":"2021","journal-title":"J. Clin. Anesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s00540-017-2361-z","article-title":"Paravertebral block catheter breakage by electrocautery during thoracic surgery","volume":"31","author":"Saeki","year":"2017","journal-title":"J. Anesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1177\/021849230801600414","article-title":"Retrieval of broken paravertebral catheter by video-assisted thoracic surgery","volume":"16","author":"Sihoe","year":"2008","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s40981-016-0074-1","article-title":"Breakage and retention of thoracic paravertebral catheter: A case report","volume":"3","author":"Fujii","year":"2017","journal-title":"JA Clin. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e82","DOI":"10.1053\/j.jvca.2018.01.009","article-title":"Retained Paravertebral Catheter Fragment during Removal. A Rare Event without Damage for the Patient","volume":"32","author":"Agrafiotis","year":"2018","journal-title":"J. Cardiothorac. Vasc. Anesth."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/6\/733\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T08:43:58Z","timestamp":1779698638000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/6\/733"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":16,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["children13060733"],"URL":"https:\/\/doi.org\/10.3390\/children13060733","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]}}}