Tunneled and Non-tunneled Epidural Catheters for Acute Post-surgical Pain

TL;DR

A 34-year-old opioid-tolerant woman used two epidural catheters for effective post-surgical pain management, reducing opioid use.

Contribution

Demonstrates successful use of dual epidural catheters in managing complex post-surgical pain in opioid-tolerant patients.

Findings

Dual epidural catheters provided effective pain control with minimal opioid escalation.

Neuraxial techniques are valuable for managing refractory perioperative pain in complex patients.

The case underscores current understanding of infectious risks with neuraxial catheters.

Abstract

Multimodal analgesia, particularly neuraxial techniques, is vital for managing perioperative pain in opioid-tolerant patients. This report describes the case of a 34-year-old woman with a complex surgical history and opioid tolerance with an indwelling tunneled thoracic epidural catheter who subsequently underwent placement of a second non-tunneled lumbar catheter for surgical pain control. The dual epidural catheters, in addition to an optimized multimodal regimen, achieved significant postoperative pain control while minimizing systemic opioid escalation. This case highlights the value of neuraxial techniques in managing refractory perioperative pain in complex, opioid-tolerant patients and underscores current knowledge about infectious risks associated with neuraxial catheters.

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