Continuous Re-MTAPA Block via SEDIC Catheter Placement: A Novel Analgesia Technique in Two Complex Surgical Cases.

Abstract

Epidural anesthesia is commonly used for perioperative pain management, but it can be challenging in patients with anatomical issues or those on anticoagulation therapy. We present two cases in which catheter placement in the space between the endothoracic fascia, diaphragm, and costodiaphragmatic recess (SEDIC) was used for postoperative analgesia. This technique was applied to two patients: one with severe thoracolumbar scoliosis (American Society of Anesthesiologists Physical Status (ASA-PS) 2) undergoing laparoscopic distal gastrectomy and another receiving antiplatelet therapy (ASA-PS 3) undergoing open abdominal aortic aneurysm repair. A continuous infusion of 0.125% levobupivacaine, supplemented with twice-daily boluses of 10 mL of 0.25% levobupivacaine via bilateral catheters, was administered. Both patients maintained Numeric Rating Scale scores below 3 throughout the observation period and did not require rescue analgesia. Continuous re-modified thoracoabdominal nerves through perichondrial approach block via SEDIC catheter placement provided effective postoperative analgesia in patients with contraindications to epidural techniques, supporting early mobilization without hemodynamic instability.