Related Experiment Video
Updated: May 20, 2026
03:14
Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
Published on: January 31, 2025
A systematic evaluation of thoracic interlaminar epidural injections
Ramsin M Benyamin1, Victor C Wang, Ricardo Vallejo
1Millennium Pain Center, Bloomington, IL, USA. ramsinbenyamin@yahoo.com
Pain Physician
|July 26, 2012
Summary
This systematic review found fair evidence for thoracic epidural injections treating chronic mid-back pain, but limited evidence for post-thoracotomy pain syndrome. More research is needed to confirm effectiveness for various thoracic pain conditions.
Area of Science:
- Pain Management
- Neurosurgery
- Spinal Interventions
Background:
- Limited literature exists on epidural injections for chronic mid-upper back pain.
- Conditions include disc herniation, spinal stenosis, and post-surgical pain.
Purpose of the Study:
- To systematically review the effectiveness of thoracic epidural injections for chronic mid-upper back pain.
- To assess outcomes with or without steroids and fluoroscopy for various thoracic pain etiologies.
Main Methods:
- Systematic review of literature from 1966 to March 2012.
- Included randomized trials (Cochrane criteria) and observational studies (Newcastle-Ottawa Scale).
- Classified evidence level as good, fair, or limited (USPSTF criteria).
Main Results:
- Included 2 studies (1 RCT, 1 observational) out of 17 identified.
- Fair evidence supports thoracic epidural injections for various causes of chronic thoracic pain.
- Limited evidence supports their use for post-thoracotomy pain syndrome.
Conclusions:
- Paucity of high-quality evidence limits definitive conclusions.
- Fair evidence exists for general thoracic pain; limited evidence for post-thoracotomy pain.
- Further research is warranted to establish efficacy and safety.
Related Concept Videos
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...