# Effective Thoracoabdominal Pain Management Using Dual Epidural Catheter Placement in Esophageal Reconstruction: A Case Report

## TL;DR

A case report shows that using two epidural catheters can effectively manage pain after complex chest and abdominal surgery, reducing the need for opioids.

## Contribution

This case report demonstrates the safe and effective use of dual epidural analgesia for thoracoabdominal pain management.

## Key findings

- Dual epidural catheters at Th5/6 and Th11/12 provided effective pain control.
- Opioid consumption was significantly reduced with minimal complications.
- Patients reported low pain scores at rest and moderate pain on movement post-surgery.

## Abstract

Background and Clinical Significance: Effective postoperative pain management is crucial in patients undergoing extensive thoracoabdominal surgery, such as esophageal reconstruction, where both thoracic and abdominal incisions are involved. In such cases, a single epidural catheter may not provide sufficient analgesic coverage. Dual epidural analgesia (DEA) offers a potential solution, allowing segmental, targeted pain control while minimizing systemic opioid exposure. Case Presentation: A 64-year-old male underwent esophageal reconstruction using a combined thoracoabdominal approach. Two epidural catheters were placed at Th5/6 and Th11/12 levels. Intraoperatively, segmental bupivacaine boluses and multimodal non-opioid intravenous analgesia were administered. Postoperatively, continuous epidural bupivacaine infusion was maintained, supplemented with morphine boluses when the numeric rating scale (NRS) was ≥5. Mean NRS scores were 2 at rest and 5 on movement on postoperative day 1 (POD1); 1 and 4 on POD2; and 3 and 5 on POD3. Total epidural morphine consumption was 36 mg over 340 h, and the 24-h bupivacaine dose was 180 mg (2.77 mg/kg/24 h). No complications were observed. Conclusions: Dual epidural analgesia provided effective, opioid-sparing multimodal pain control in complex thoracoabdominal surgery. This case highlights DEA as a safe and feasible approach when single-catheter coverage is inadequate, supporting enhanced recovery and reduced opioid use after esophageal reconstruction.