What are the indications for thoracic epidural spinal blocks in pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Thoracic epidural spinal blocks with local anesthetics and/or opioids may be used to palliate acute pain emergencies while waiting for pharmacologic, surgical, and/or antiblastic methods to become effective. This technique is useful in the management of postoperative pain as well as pain secondary to trauma. The pain of acute herpes zoster, acute pancreatitis, and cancer-related pain are also amenable to treatment with epidurally administered local anesthetics, steroids, and/or opioids. The administration of local anesthetics and/or steroids via the thoracic approach to the epidural space is useful in the treatment of various chronic benign pain syndromes, including thoracic radiculopathy, thoracic postlaminectomy syndrome, vertebral compression fractures, chronic pancreatitis, diabetic polyneuropathy, chemotherapy-related peripheral neuropathy, postherpetic neuralgia, and reflex sympathetic dystrophy of the chest wall.

The mid-thoracic epidural administration of local anesthetics in combination with steroids and/or opioids is also useful in the palliation of cancer-related pain of the chest wall and intrathoracic organs. This technique has been especially successful in the relief of pain secondary to metastatic disease of the spine. The long-term epidural administration of opioids has become a mainstay in the palliation of many cancer-related pain disorders. [20]

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