Dual epidural catheter technique to provide opioid-free anaesthesia for an open abdominoperineal resection

Abstract

The peri-operative analgesic management of patients undergoing major elective colorectal surgery has an impact on patient recovery. An approach that favours an opioid-free strategy has demonstrated improved patient outcomes. Avoiding systemic opioids during and after abdominal surgery promotes early recovery of bowel function and early re-initiation of oral intake, shortens hospital length of stay, minimises postoperative complications, and may improve long-term outcomes. In this case report we describe an opioid-free anaesthetic technique, in line with current Enhanced Recovery After Surgery recommendations, for a patient undergoing an open abdominoperineal resection who reported experiencing severe side-effects to opioids in the past. Two epidural catheters were sited pre-operatively at the interspaces between the ninth and tenth thoracic and third and fourth lumbar vertebrae respectively, and used intra- and postoperatively. The utilisation of two epidural catheters not only ensured complete peri-operative analgesia, but also successfully attenuated the neuroendocrine stress response to surgery. The dual epidural catheter technique may be considered for extensive colorectal surgery when conventional opioid-based anaesthetic techniques are contraindicated.

Keywords: epidural analgesia: complications; epidural local anaesthetic: GI effect; stress response: metabolic effect.

Figure 1

Patient in sitting position with dual epidural catheters sited preoperatively (T9/T10 and L3/L4 respectively).