Neuraxial Analgesia in the ICU: Epidural and Paravertebral Blocks

  • Adam Penman
  • Sanaz Ghaffari
  • Michel KearnsEmail author


  • The epidural space surrounds the dura and contains fat, lymphatics, blood vessels, connective tissue, and nerve roots (primary site of action for local anesthetics).

  • When compared to the dense motor and sensory blockade of a spinal injection, epidural catheters provide controlled segmental analgesia spanning 2–3 spinal cord levels above and below level of insertion, with minimal motor blockade.

  • Achieving desired sensory blockade level depends on the type, concentration, and volume of local anesthetic solution.

  • Advantages of neuraxial analgesia include (1) minimizing parenteral opioids and their associated complications, (2) decrease rate of nosocomial pneumonia, and (3) shorter duration of mechanical ventilation in patients with rib fractures.

  • Spinal and/or epidural hematoma, as a result of catheter insertion or removal, is a rare but potentially devastating complication in the context of coagulopathy or patients taking anticoagulant medication.

  • Any patient with relative contraindications or complications should receive prompt consultation with an anesthesiologist or a member of the acute pain management team.

  • Epidural catheter placement should only be performed by those with the technical expertise and a substantial amount of experience in the placement of this regional anesthesia technique.

  • Paravertebral blockade has become more prevalent in the ICU, especially for pain associated with unilateral rib fractures, breast surgery, and thoracic surgery.
    • The success rate and analgesic efficacy of paravertebral blocks are similar when compared to thoracic epidural catheter placement.

    • Compared to epidural analgesia, paravertebral blockade is safer to perform and results in less hypotension and urinary retention.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Southern CaliforniaLos AngelesUSA

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