A thoracic epidural is a medical procedure in which medication is injected through the dura membrane of the spine into the epidural space. This medication then interferes with the nerves in the spinal cord that are responsible for pain; it is often used to provide relief or act as an anesthetic during surgery. The term thoracic refers to the upper back area of the spinal cord into which the epidural is injected. This procedure is used for operations involving the upper abdomen or upper back or to relieve chronic back pain.
The term thoracic refers to the thoracic vertebrae, which is a set of vertebrae in the middle of the back. This part of the backbone is connected to the rib cage. This connection to the rib cage has important implications when using a thoracic epidural because the medication can cause difficulty breathing during the procedure.
Patients receive this epidural while lying on their sides. The doctor will first prepare the back with soaps and iodine. He will then numb the area and inject a needle into the epidural space. If the injection is for surgery, the doctor will place a catheter at the injection site; if it is being used to treat chronic back pain, there is no catheter.
A highly skilled anesthesiologist is required to perform a thoracic epidural. If the catheter is placed too high, it can cause respiratory problems. It is also important that it be placed in the proper place to target the correct pain receptors. With proper placement and care, the epidural catheter can stay in place for several days without risk of infection.
There are complications associated with a thoracic epidural. The most common problems involve the catheter, such as kinking or a block in the line. Some less common complications include bleeding, dural puncture, backache, respiratory problems, or pieces of the catheter becoming stuck. Serious, but rare complications include an abscess, epidural hematoma, or spinal chord injuries.
Thoracic epidurals that do not involve catheters are used to treat acute and chronic back pain. Individuals receiving these are asked to keep a pain log afterward to determine if the epidurals improved their conditions. In these situations, the epidural is anti-inflammatory in nature and typically is received every two to three weeks. It is important that patients do not take any other pain medications on the day of the epidural, as they must be able to feel the pain before the injection in order to gauge its effectiveness.
