{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T15:31:33Z","timestamp":1762183893262,"version":"build-2065373602"},"reference-count":12,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>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 \u22655. 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.<\/jats:p>","DOI":"10.3390\/reports8040223","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T13:55:22Z","timestamp":1762178122000},"page":"223","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effective Thoracoabdominal Pain Management Using Dual Epidural Catheter Placement in Esophageal Reconstruction: A Case Report"],"prefix":"10.3390","volume":"8","author":[{"given":"Elizabete","family":"Svareniece-Karjaka","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Riga East Clinical University Hospital, Hipokrata Street 2, LV-1038 Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6650-483X","authenticated-orcid":false,"given":"Anna","family":"Junga","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Riga East Clinical University Hospital, Hipokrata Street 2, LV-1038 Riga, Latvia"},{"name":"Department of Morphology, Riga Stradi\u0146\u0161 University, LV-1007 Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aleksandrs","family":"Mala\u0161onoks","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Riga East Clinical University Hospital, LV-1038 Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6922-0533","authenticated-orcid":false,"given":"Agnese","family":"Ozoli\u0146a","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Riga East Clinical University Hospital, Hipokrata Street 2, LV-1038 Riga, Latvia"},{"name":"Department of Anesthesiology, Intensive Care and Clinical Simulation, Riga Stradi\u0146\u0161 University, LV-1007 Riga, Latvia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"M\u0103rg\u0103rit, S., Barto\u0219, A., Laza, L., Osoian, C., Turac, R., Bondar, O., Leucu\u021ba, D.-C., Munteanu, L., and Vasian, H.N. (2023). Analgesic Modalities in Patients Undergoing Open Pancreatoduodenectomy\u2014A Systematic Review and Meta-Analysis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12144682"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1213\/XAA.0000000000000907","article-title":"Dual epidural catheter therapy for abdominal surgery pain: Two Case reports","volume":"12","author":"Li","year":"2019","journal-title":"A&A Pract."},{"key":"ref_3","first-page":"98","article-title":"Dual thoracic and caudal epidural catheters for abdominoperineal resection: A case report","volume":"5","author":"Edelson","year":"2021","journal-title":"Pain Med. Case Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"107350","DOI":"10.1016\/j.ijscr.2022.107350","article-title":"Double epidural catheter technique in a patient with severe COPD undergoing major abdominal surgery: A case report","volume":"96","author":"Compagnone","year":"2022","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Sarridou, D.G., Mouratoglou, S.A., Mitchell, J.B., Cox, F., Boutou, A., Braoudaki, M., Lambrou, G.I., Konstantinidou, M., Argiriadou, H., and Walker, C.P.R. (2023). Post-operative thoracic epidural analgesia and incidence of major complications according to specific safety standardized documentation: A large retrospective dual-center experience. J. Pers. Med., 13.","DOI":"10.3390\/jpm13121672"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1111\/anae.15282","article-title":"Updates in our understanding of local anaesthetic systemic toxicity: A narrative review","volume":"76","author":"Macfarlane","year":"2021","journal-title":"Anaesthesia"},{"key":"ref_7","unstructured":"Wind, J.J., and Joseph, D.P. (2025, September 08). Local and regional anesthesia in ophthalmology and ocular trauma, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK572107\/."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s13741-025-00521-z","article-title":"Dosage of epidural morphine analgesia after lower abdominal cancer surgery: A randomized clinical trial among the older adults","volume":"14","author":"Shawqi","year":"2025","journal-title":"Perioper. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Xu, W., Liu, Y., Chen, Y., Wang, M., Luo, X., and Gong, Z. (2022). Combination of thoracic epidural analgesia with patient-controlled intravenous analgesia enhances pain control and facilitates early recovery after laparotomy: A randomized controlled trial. BMC Anesthesiol., 22.","DOI":"10.1186\/s12871-022-01891-3"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1136\/rapm-2022-104303","article-title":"Migration rate of proximal adductor canal block catheters placed parallel versus perpendicular to the saphenous nerve after total knee arthroplasty: A randomized controlled study","volume":"48","author":"Fujino","year":"2023","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Pakpirom, J., Thatsanapornsathit, K., Kovitwanawong, N., Yuki, S., Tsubasa, A., Yasuhiro, A., Masataka, F., Takashi, H., Chika, I., and Eiki, K. (2022). Real-time ultrasound-guided versus anatomic landmark-based thoracic epidural placement: A prospective, randomized, superiority trial. BMC Anesthesiol., 22.","DOI":"10.1186\/s12871-022-01730-5"},{"key":"ref_12","first-page":"1843","article-title":"Dual-Epidural Catheter Technique and Perioperative Outcomes after Ivor-Lewis Esophagectomy","volume":"94","author":"Brown","year":"2012","journal-title":"Ann. Thorac. Surg."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/4\/223\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T14:44:18Z","timestamp":1762181058000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/4\/223"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":12,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["reports8040223"],"URL":"https:\/\/doi.org\/10.3390\/reports8040223","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]}}}