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Ann Card Anaesth. 2019 Oct-Dec;22(4):383-387. doi: 10.4103/aca.ACA_169_18.

High vs mid thoracic epidural analgesia - A comparative study on the ease of insertion and effects on pain, hemodynamics, and oxygenation in patients undergoing thoracotomies.

Author information

Department of Cardiac Anaesthesia, Narayana Institute of Cardiac Sciences, Bommasandra Industrial Area, Anekal Taluk, Bangalore, Karnataka, India.
Department of Anesthesiology and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Department of Cardio Thoracic Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.



Thoracic epidural analgesia offers effective perioperative pain relief in patients undergoing thoracotomies apart from attenuating stress responses. It helps in fast tracking by facilitating early mobilization and improving respiratory function. Literature on high (T1-T2 level) thoracic segmental analgesia for thoracotomy is less.


The aim of present study was to compare the ease of insertion, effect on pain relief in high (T1-T2 level) vs mid (T5-T6) approach of thoracic epidural.

Setting and Design:

The present study was a randomized control trial conducted at our institute.

Materials and Methods:

About 52 patients aged between 18-65 years scheduled for elective thoracotomies under general and thoracic epidural anesthesia were randomized into two groups. Intraoperatively ease of epidural insertion, extent of blockade, and postoperatively pain relief were assessed. Ropivacaine with fentanyl was used for epidural analgesia.

Statistical Analysis:

Data were presented as mean ± standard deviation and analyzed by the Student's t test, Chi-square test, and non-parametric test whereever applicable. A P value <0.05 was considered statistically significant.


We observed that high thoracic epidural anesthesia was easier to place (time taken 123.42 vs 303.08 s) P < 0.05, with less number of attempts (1.27 vs 1.92) P < 0.05. Extent of blockade, postoperative pain scores, rescue analgesia requirement, hemodynamics, and oxygenation were comparable.


We conclude that high thoracic epidural is easier to insert, provides adequate pain relief, and stable hemodynamics with the advantage of patient comfort and safety.


Ease of technique; high thoracic epidural; pain relief; ropivacaine; thoracotomies

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