{
  "abstract": "Application for ESRA Abstract Prizes : I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims Epidural analgesia (EA) is commonly used in major surgeries; however, placement of dual epidural analgesia (DEA) catheters remains rare. In selected cases, DEA may provide broader segmental coverage and opioid-sparing benefits despite added complexity.Methods A 64-year-old male (65 kg) underwent thoracolaparotomy with esophageal and gastric cardia resection and gastroplasty for gastroesophageal junction cancer in January 2025. Postoperatively, complete anastomotic dehiscence developed, requiring esophageal stump drainage and VAC system application. Three months later, esophageal reconstruction with colonic interposition was planned. Anticipating thoracotomy and laparotomy, DEA catheters (B.Braun Perifix®, Germany) were placed at Th5/6 and Th11/12 (6 cm depth) for opioid-sparing anesthesia and analgesia. Dermatomal coverage was Th3–8 and Th9-L2. Bupivacaine (Bupivacaine-Grindeks spinal, Grindex, Latvia) 0.25% 5 ml was administered every 90 minutes via both catheters, starting with Th11/12 and then Th5/6. Multimodal IV analgesia included paracetamol (Supofen® 10 mg/ml, Laboratórios Basi - Indústria Farmacêutica S.A., Portugal), metamizole (Metamizole Sodium-Kalceks 500 mg/ml, Kalcex, Latvia), ketorolac (Ketanov 30 mg/ml, Sun Pharmaceutical Industries Europe B.V., Netherlands), and dexamethasone (Dexamethasone Kalceks 4 mg/ml, Kalcex, Latvia). During the 530-minute surgery, the patient received 0.2 mg fentanyl (Fentanyl citrate-Kalceks 0.05 mg/ml, Kalcex, Latvia) and a low dose of noradrenaline (Norepinephrine Kabi 1 mg/ml, Fresenius Kabi, Poland). Postoperatively, a continuous epidural infusion of 0.125% bupivacaine (3 ml/h) was maintained via both catheters as part of multimodal analgesia. Pain scores were NRS 0–3 at rest and 3–6 with movement. Epidural morphine was used when NRS >5. No IV opioids were needed. DEA catheters were removed on POD14. No complications related to DEA were observed.Results DEA enabled effective segmental coverage and reduced opioid requirements. The total bupivacaine dosage remained within the established safety thresholds, and no complications were observed.Conclusions DEA proved to be a safe and effective opioid-sparing strategy in extensive thoracoabdominal surgery, particularly when single-catheter EA may be insufficient.",
  "authors": [
    {
      "affiliations": [
        "Anesthesia Clinic, Riga East University Hospital, Riga, Latvia"
      ],
      "name": "Elizabete Svareniece-Karjaka"
    },
    {
      "affiliations": [
        "Clinic of Oncologic Surgery, Riga East University Hospital, Riga, Latvia"
      ],
      "name": "Aleksandrs Malasonoks"
    },
    {
      "affiliations": [
        "Anesthesia Clinic, Riga East University Hospital, Riga, Latvia",
        "Department of Anaesthesiology and Intensive Care, Riga Stradiņš University, Riga, Latvia"
      ],
      "name": "Agnese Ozolina"
    },
    {
      "affiliations": [
        "Anesthesia Clinic, Riga East University Hospital, Riga, Latvia",
        "Department of Morphology, Riga Stradiņš University, Riga, Latvia"
      ],
      "name": "Anna Junga"
    }
  ],
  "title": "P013 Dual epidural catheter placement for thoracoabdominal analgesia in esophageal reconstruction: a case report",
  "uid": "f6405837-f338-5c80-9de9-18fcbe3eada9"
}