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Avoid suboptimal perioperative analgesia during major surgery by enhancing thoracic epidural catheter placement and hemodynamic performance
  1. Sarah A Bachman1,
  2. Johan Lundberg2 and
  3. Michael Herrick1
  1. 1Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  2. 2Intensive and Perioperative Care, Faculty of Medicine, Lunds University, Lund, Sweden
  1. Correspondence to Dr Sarah A Bachman, Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756-1000, USA; sarah.a.bachman{at}


Thoracic epidural analgesia (TEA) is an established gold standard for postoperative pain control especially following laparotomy and thoracotomy. The safety and efficacy of TEA is well known when the attention to patient selection is upheld. Recently, the use of fascial plane blocks (FPBs) has evolved as an alternative to TEA most likely because these blocks avoid problems such as neurological comorbidity, coagulation disorders, epidural catheter failure and hypotension due to sympathetic denervation. However, if an FPB is performed, postoperative monitoring and adjuvant treatments are still necessary. Also, the true efficacy of FPBs is questioned. Thus, should we prioritize less efficient analgesic regimens with FPBs when preventive treatment strategies for epidural catheter failure and hypotension exist for TEA? It is time to promote and underscore the benefits of TEA provided to patients undergoing major open surgical procedures. In our mind, FPBs and landmark-guided techniques should be limited to less extensive surgery and when either neuraxial blockade is contraindicated or resources for optimal epidural catheter placement and maintenance are not available.

  • analgesia
  • anesthesia
  • local
  • pain
  • postoperative
  • regional anesthesia

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  • Contributors All authors contributed to the ideas, background research and writing of this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement There are no data in this work.