Risks and complications of thoracic epidural anaesthesia

Thoracic epidural catheterization does not appear to be associated with more, or more serious, complications than lumbar epidural catheterization. Large prospective studies in patients undergoing abdominothoracic surgery did not reveal catheter-related permanent neurological injuries, the predicted maximum risk of which can be estimated to be of the order of 0.07%. Patients receiving epidural hydrophilic or lipophilic opioids should be monitored with the same level of care for respiratory depression. Clinically there is no apparent advantage in using morphine, fentanyl or sufentanil alone via the thoracic epidural route when compared with lumbar epidural or intravenous administration for postoperative pain relief. The combined administration of local anaesthetics via the thoracic epidural route plays a pivotal role for the success of this method.