Tunnelled caudal catheter for perioperative analgesia in a woman with acute on chronic pelvic pain

Summary 

Objective

This report outlines the use of an uncommon technique in current adult anaesthesia for the relief of pain pre and post-operatively, and the prevention of long-term sequelae of unrelieved pain. The tunnelling technique of the caudal catheter is briefly described.

Case report

A young woman with chronic back pain who had a more recent acute vaginal pain secondary to a vaginal wall cyst was admitted to hospital for 1 week prior to her scheduled surgery because of incapacitating vaginal pain. This case report describes the insertion of a caudal epidural catheter pre-operatively to control severe pain and its continuation both intra and post-operatively. The block was initiated with lignocaine and pethidine and maintained with an infusion of levobupivacaine and pethidine with the advantage of patient-administered boluses whenever required. The catheter was tunnelled to the right gluteal region and successful pain relief was achieved. This strategy accomplished better analgesia coupled with reducing the medication the patient had been taking for her pain syndromes.

Conclusions

Caudal analgesia was utilized in the hope of a better anatomical and pharmacological control of acute severe pain. This consequently reflected on a superior management of mental state in hospital. The catheter was left in situ until the day before discharge from hospital. No complications arose and conventional analgesics and mood stabilising drug doses were significantly reduced whilst the patient was hospitalised.

Keywords: Caudal analgesia, Tunnelled epidural catheter, Preventive analgesia