Thoracic Epidural Analgesia: Do the Alternatives for Abdominal Surgical Pain Control Measure up?

Thoracic epidural analgesia (TEA) is well-known as the gold standard for perioperative somatic and visceral analgesia in abdominal surgery. Recently, there has been a shift away from TEA with the emergence of alternative pain control techniques such as fascial plane blocks (FPBs). Proponents of these alternatives often note the high failure rate of TEA, which can reach up to 25%. The alternatives to TEA are not a panacea. Important techniques have emerged to improve upon the reliability of TEA. In cases where TEA is contraindicated or impractical, alternatives including intrathecal morphine, peripheral nerve blocks, and FPBs may be suitable alternatives.