Article Text

Download PDFPDF
An Unusual Cause of Acute Chest Pain During Epidural Anesthesia
  1. Englok Yap, M.D.,
  2. John Dilger, M.D. and
  3. John E. Tetzlaff, M.D.
  1. From the Pain Management Center and Department of General Anesthesiology, The Cleveland Clinic Foundation, Cleveland, Ohio.
  1. Reprint requests: John E. Tetzlaff, M.D., Department of General Anesthesiology, The Cleveland Clinic Foundation, Cleveland, OH 44195.


Background and Objectives Selective sympathetic denervation during epidural anesthesia results in a small, active gut. These changes can also result in selective activity in one segment of the gut that is absent in other segments.

Case Report A 61-year-old male was scheduled for bilateral total knee replacement during epidural anesthesia. Following onset of the epidural block, he experienced severe left-sided chest pain. Surgery was canceled. A portable chest radiograph revealed a widened mediastinum, and he underwent angiography to rule out a dissecting thoracic aortic aneurysm. The left subclavian artery could not be visualized, and an MRI was obtained, which was normal. After his return to the intensive care unit, he had a large bowel movement and his chest pain resolved.

Conclusion Selective activity of the gastrointestinal tract during the onset of epidural anesthesia created a visceral pain, which effectively simulated pain with a cardiovascular origin.

  • regional anesthesia
  • epidural anesthesia
  • thoracic aortic aneurysm
  • epidural physiology
  • mepivacaine
  • total knee replacement.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.