Thoracic epidural anesthesia and analgesia

The use of thoracic epidural anesthesia has been controversial in the past because it was not certain whether thoracic epidural anesthesia could provide better anesthesia and analgesia than general anesthesia or lumbar epidural anesthesia. However, many studies now support the concept that thoracic epidural anesthesia is a valuable means of providing effective anesthesia and analgesia with lower doses of anesthetics. Thoracic epidural anesthesia has also been shown to have a positive effect on pulmonary function demonstrated by increased vital capacity and earlier extubation. These positive effects may be the result of improved diaphragmatic activity combined with effective pain relief. The hemodynamic effects of thoracic epidural anesthesia are more variable, depending on which dermatomal segments are blocked. The effects of thoracic epidural anesthesia on surgical stress are somewhat less clear, and further studies will provide more information. Although fear of complications such as dural puncture, epidural hematoma or abscess, damage to the spinal cord and prolonged paresthesiae often prevent the widespread clinical practice of thoracic epidural anesthesia, a low incidence of these complications has been documented. Furthermore, if procedural guidelines are carefully followed, the risk of complications is greatly diminished. A better postoperative outcome has been repeatedly demonstrated in patients with thoracic epidural anesthesia when compared with general anesthesia, which supports the use of thoracic epidural anesthesia in clinical practice. Although thoracic epidural anesthesia has been shown to be only marginally more effective than lumbar epidural anesthesia, the effects of higher doses of anesthetics required for lumbar epidural anesthesia may be of concern, especially for high-risk patients.