We report the occurrence of an accidental pleural puncture by an epidu
ral catheter that happened during the attempted induction of thoracic
epidural anaesthesia using a paramedian approach in an awake patient.
The incorrect placement of the catheter was recognised while the patie
nt was undergoing thoracoscopic surgery. The possibility of accidental
pleural puncture during attempted thoracic epidural catheter placemen
t by either the paramedian or the midline approach should be borne in
mind. A misplaced catheter may injure lung tissue and result in a pote
ntially dangerous intra-operative tension pneumothorax.