Rashmi Syal, MD 1, Priyanka Sethi, MD 2, Karma Onugu, MD 3, Manbir Kaur, MD 4
Author affiliation:
Allergic contact dermatitis is an immune reaction to an allergen. Allergy to various surgical dressings and catheters have been reported earlier.1 There are no reports on allergic reaction to micropore at epidural insertion site. We report an adverse skin reaction resulting from the application of Micropore™ frequently used to secure perineural catheters.2
A 28-year old male underwent intramedullary nailing for femur fracture under combined spinal epidural following a road traffic accident. After inserting the epidural catheter followed by spinal anaesthesia, a 3M™ Tegaderm™ transparent film dressing was used to fix the catheter along with Micropore™ surgical tape. The patient had no complaints intraoperatively and during follow-up. Next day, he complained of itching at the site; and we observed redness around the lumbar region with small vesicles (Figure 1). Epidural catheter was removed and the patient was shifted on oral analgesics. The case was diagnosed as irritant contact dermatitis by the dermatologist for which topical steroid (clobestol propionate 0.5%) was advised twice daily. A viral culture of the vesicles was found to be negative for herpes simplex virus. The lesion eventually healed completely and the patient was discharged on the 6th day following surgery.
Tegaderm™, Micropore™ or Transpore™ are frequently used for fixation of the epidural catheters. Anesthesiologists need to be aware of the risks associated with these common skin adhesives films or tapes. Regular follow up with early diagnosis and prompt management can help in rapid resolution.
Also, large transparent tegaderms to secure the whole catheter can be made, so that these skin reactions be minimised. Though reports of contact dermatitis with micropore are present but are extremely rare.3
References
Figure 1: Showing allergic contact dermatitis at epidural catheter fixation site
Author affiliation:
- Rashmi Syal, MD, Assistant Professor, Department of Anesthesiology and Critical Care, Dr SN Medical College, India-342005; E-mail: rashmisyal2006@gmail.com
- 2. Priyanka Sethi, Associate Professor, Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India-342005; E-mail: dr.priyanka_sethi@yahoo.co.in
- Karma Ongmu Bhutia, Junior Resident, Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India-342005; E-mail: karmaOngmu1@gmail.com
- Manbir Kaur, Assistant Professor, Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India-342005; E-mail: doctor.manbir@gmail.com
Allergic contact dermatitis is an immune reaction to an allergen. Allergy to various surgical dressings and catheters have been reported earlier.1 There are no reports on allergic reaction to micropore at epidural insertion site. We report an adverse skin reaction resulting from the application of Micropore™ frequently used to secure perineural catheters.2
A 28-year old male underwent intramedullary nailing for femur fracture under combined spinal epidural following a road traffic accident. After inserting the epidural catheter followed by spinal anaesthesia, a 3M™ Tegaderm™ transparent film dressing was used to fix the catheter along with Micropore™ surgical tape. The patient had no complaints intraoperatively and during follow-up. Next day, he complained of itching at the site; and we observed redness around the lumbar region with small vesicles (Figure 1). Epidural catheter was removed and the patient was shifted on oral analgesics. The case was diagnosed as irritant contact dermatitis by the dermatologist for which topical steroid (clobestol propionate 0.5%) was advised twice daily. A viral culture of the vesicles was found to be negative for herpes simplex virus. The lesion eventually healed completely and the patient was discharged on the 6th day following surgery.
Tegaderm™, Micropore™ or Transpore™ are frequently used for fixation of the epidural catheters. Anesthesiologists need to be aware of the risks associated with these common skin adhesives films or tapes. Regular follow up with early diagnosis and prompt management can help in rapid resolution.
Also, large transparent tegaderms to secure the whole catheter can be made, so that these skin reactions be minimised. Though reports of contact dermatitis with micropore are present but are extremely rare.3
References
- Marks JG Jr, Rainey MA. Cutaneous reactions to surgical preparations and dressings. Contact Dermatitis. 1984;10:1-5. [PubMed] DOI: 1111/j.1600-0536.1984.tb00051.x
- Williams BA, Bolland MA, Orebaugh SA, Bottegal MT, Kentor ML. Skin reactions at the femoral perineural catheter insertion site: retrospective summary of a randomized clinical trial. Anesth Analg. 2007;104:1309-10. [PubMed] DOI: 1213/01.ane.0000260353.11142.d4
- Meikle A, Vaghadia H, Henderson C. Allergic contact dermatitis at the epidural catheter site due to Mastisol® liquid skin adhesive. Can J Anaesth. 2012 Aug;59(8):815-6. [PubMed] DOI: 1007/s12630-012-9732-6
Figure 1: Showing allergic contact dermatitis at epidural catheter fixation site