Thoracic epidural anaesthesia and analgesia

Thoracic epidural anaesthesia followed by postoperative epidural analgesia is increasingly being used for abdominal, major vascular and cardiothoracic surgery. The objective of thoracic block is not solely to block noxious afferent stimuli from the surgical site, but to impart a bilateral selective thoracic sympathectomy. Provision of pain relief and sympatholysis of such magnitude that allows patients to cough, breath deeply, drink and mobilize can contribute to enhanced postoperative outcomes such as improved respiratory function, reduction in ileus and protein sparing. The challenge is how to translate the encouraging results of randomized controlled studies and meta-analyses into clinical practice. Provision of sufficient intraoperative epidural anaesthesia such that the patient awakes pain-free and maintenance of a continuous bilateral sensory block covering the entire surgical site for several days is not an easy task. The aim of this review is to discuss the practical issues related to thoracic epidural analgesia.