1) Surgery and post operative analgesia
it is used in the operation in the region of thorax and upper abdomen.
2) Acute Herpes Zoster and post-herpetic neuralgia.
Herpes infection is most common in thoracic area. Pain may be relived by administration of epidural local anesthesia and steroids. Epidural cathetal may be test close to the involved nerve root provide excellent analgesia. Cathetar is left for 2 to 3 days.
3) Herniated discs / Nerve root irritation
Epidural steroid mixed with normal saline or local anesthetic is advocated in the treatment of Herniated discs / Nerve root irritation.
4) Pain in trauma
Thoracic epidural block with local anesthetic with or without Opioid are administrated in multiple fractured rib and fractured vertebra. This can be administered through epidural catheter. This form of treatment provides excellent analgesia and improves ventilatory function.
Angina secondary to myocardial ischeamia can be treated with thoracic epidural block. It provides excellent analgesia decreases myocardial oxygen consumption decreases anxiety associated with pain and also decreases catecholamine labels.
6) Cancer pain
Cancer pain can be relived with tunneled epidural catheter using opioids with/without local anesthetic for epidural block.
7) Acute Pancreatitis
Severe pain of acute pancreatitis can be relived with epidural block with the help of epidural catheter.
The spine of the thoracic vertebra is highly angulated in the main thoracic region especially from T5-T9. So classical midline approach is not possible in this area. Paramedial approach or interlaminar approach is advocated to reach the epidural space.
Complications of thoracic epidural technique are rare in expert hands. Potential complications are infection, hematoma, injury to the nerve roots, respiratory depression, sub-arachnoid/subdural injection of drugs etc. There are very few reports of this complications and incident of spinal cord damage is not known. In one study of 1071 patients and in another study of 4185 patients no serious complications were reported.