Thoracic Epidural Block (Landmark, X-Ray-Guided, and Ultrasound-Guided Methods)

  • Keiko MamiyaEmail author


Thoracic epidural block affects spinal nerves and sympathetic nerves of the thorax and can therefore be applied not only as analgesia of the thoracic spinal nerve region but also for control of complex regional pain syndrome (CRPS) in the upper arm; disturbance of peripheral blood circulation, such as Raynaud’s disease; and sympathetic nerve-dependent pain. The best-known procedure is the landmark method followed by X-ray-guided block and ultrasound-guided block. The landmark method has a longer history than the others and is well established, but the latter two methods are indicated in cases in which it is challenging to perform epidural block, such as cases of spinal deformity or severe obesity and in cases in which it is necessary to carefully decide the puncture point, such as herpes zoster patients. In pediatric cases or in obese patients, ultrasound-guided block is applied to select the puncture point or to measure the distance from the skin to the epidural space by pre-scanning prior to the procedure.


Thoracic epidural block Landmark Ultrasound-guided X-ray-guided 


  1. 1.
    Hamaguchi S, Kitajima T. Thoracic epidural block. Pain Clinic. 2006;27(10):S351–9.Google Scholar
  2. 2.
    Sasaki J, Kikuchi H. Thoracic epidural block, nerve block. Kobe: Sinko Koeki; 2000. p. 215–8.Google Scholar
  3. 3.
    Naganuma Y. Epidural block, pain clinic. 2nd ed. Tokyo: Igakushoin. p. 50–5.Google Scholar
  4. 4.
    Mizobuchi S. Epidural Spinal Block, Atlas of Anatomy for Regional Nerve Blocks multi-view point and multi-layer 3D color photographs MEDSi. p 113–120.Google Scholar
  5. 5.
    Deschner B, Allen M, de Leon O. Epidural blockade, textbook of reginal anesthesia. New York: Mc Graw Hill. p. 229–67.Google Scholar
  6. 6.
    Hashimoto K. X-ray-guided epidural block, pitfalls & knack for pain clinicians. Tokyo: Nakayama Shoten; 2007. p. 122–4.Google Scholar
  7. 7.
    Willschke H, Marhofer P, Bösenberg A, et al. Epidural catheter placement in children: comparing a novel approach using ultrasound guidance and a standard loss-of-resistance technique. Br J Anaesth. 2006;97(2):200–7.CrossRefGoogle Scholar
  8. 8.
    Kil HK, Cho JE, Kim WO, et al. Prepuncture ultrasound-measured distance: an accurate reflection of epidural depth in infants and small children. Reg Anesth Pain Med. 2007;32(2):102–6.PubMedGoogle Scholar
  9. 9.
    Menacé C, Choquet O, Abbal B, et al. Real-time ultrasound-guided epidural anaesthesia technique can be improved by new echogenic Tuohy needles: a pilot study in cadavers. Br J Anaesth. 2014;113(2):299–301.CrossRefGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Palliative MedicineShinshu University HospitalMatsumotoJapan

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