Complications of Thoracic Wall Regional Anesthesia and Analgesia

There are a multitude of approaches to anesthesia and analgesia of the torso, each with their own advantages and risks. The gold standard is thoracic epidural anesthesia, while recent approaches aim to refine the anesthetized area, increasing safety and comfort. Thoracic epidurals cover the largest area and offer significant pain control following procedures of the chest wall. While incidences of direct damage to the spinal cord are rare, hemodynamic changes, specifically hypotension, are a major potential complication. Paravertebral blocks have the advantage of anesthetizing specific dermatomes while sparing inferior regions that would be blocked by an epidural. Paravertebral blocks are also amenable to ultrasound guidance and continuous catheter infusion. The risk of epidural, subdural, subarachnoid, intravascular, and pleural puncture is present and can be avoided by good anatomical knowledge and attention to technique. Intercostal blocks are another alternative to thoracic epidural analgesia and can be performed under ultrasound guidance. Complications are rare but may include pneumothorax, hematoma, and intravascular injection.