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

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.