Leaving Against Medical Advice With an Indwelling Epidural Catheter in Place: A Case Report.

A male in his 30s underwent retroperitoneal mass excision. A T8-T9 epidural catheter was placed for postoperative analgesia, infusing 0.0625% bupivacaine and 2 µg/mL fentanyl at 8 mL/h. That evening, the patient left against medical advice (AMA) while declining epidural catheter removal. The patient returned 2.5 hours later for an uneventful epidural removal. We examine the clinical, legal, and ethical considerations of a patient leaving AMA with a neuraxial catheter. While medical ethics and US law guarantee patient autonomy, this situation conflicts with obligations to prevent harm including potential neuraxial infection, hematoma, or retained catheter fragments. We describe our response to this scenario and discuss steps to mitigate this uncommon but high-stakes situation.