Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: Given the wide-reaching effects of the opioid crisis in the United States and around the world, it is incumbent on anesthesiologists to create effective ways to limit the necessity of opioids for patients after their hospital stays and surrounding their experiences in the operating room. Ultrasound-guided dual thoracic and caudal epidural catheter placement has been used in a limited amount of surgery types but is one way in which anesthesiologists can improve the hospital experience and limit postoperative pain requiring opioids.
CASE REPORT: We describe a novel use of ultrasound-guided dual thoracic and caudal epidural catheter placement for postoperative pain management in abdominoperineal resection (APR) as a successful opioid-sparing strategy in this case report of 2 patients. It is significant that we chose this option for pain management in an APR procedure because this type of surgery spans multiple noncontiguous dermatomes.
CONCLUSION: The described technique, while difficult to deliver, is an excellent option for noncontiguous multidermatomal surgeries. Notably, our patients required far fewer opioids for pain management postoperatively than expected given the extensive nature of this surgery.
KEY WORDS: Abdominoperineal resection, caudal analgesia, dual catheter epidural, epidural analgesia, postoperative analgesia