Abstract:
Background: Thoracic epidural nerve block (TENB) is a technique in which analgesia is produced by
injecting local anesthetic agent by itself or combined with additives or alone into the epidural space. This
systematic review was designed to improve the quality of pain management and to form a common
consensus for TENB based on the current evidences.
Methods: PubMed through HINARI was used to get access for current and updated evidences on TENB for
cardio-thoracic and major abdominal surgeries. The flow diagram was used to show the filtration
methods of suitable literature.
Discussion: TENB should be started after checking baseline vital signs and after preparation of emergent
phenomenon. The prominent part of C7, T3 scapular spine and the inferior border of T7 are used to
localize the intended segment during performing the procedures. Skin infiltration with aseptic technique
of 2e3 ml of 2% lidocaine, test dose of 3 ml of lidocaine with 1:200,000 epinephrine, and loading dose of
3e5 ml of 0.25e0.5% bupivacaine are recommended for TENB. The maintenance dose is 3e5 ml of 0.1
e0.25% of bupivacaine. The thoracic epidural catheter will not stay for more than 4 days. Post-procedural
care and monitoring should be performed for patients on thoracic epidural catheter.
Conclusion: Generally, appropriate preoperative patient evaluation, pre-procedural preparation of the
necessary materials, and consideration of the possible options should be mandatory. Anesthetists should
be familiar with the landmark techniques, troubleshooting, administration of safe doses of the drug, and
post-epidural catheter insertion care.
© 2020 The Author(s). Published by Elsevier Ltd on behalf of Surgical Associates Ltd. This is an op
