Thoracic epidural analgesia for open cordotomy.

Surgical management of chronic pain due to malignancy includes cordotomies designed to interrupt selectively the anterolateral ascending sensory fibers (1). The results are critically dependent on the degree of completeness of pain interruption, and only pain fibers. The incision into the cord, if too small, may lead to inadequate pain relief whereas, if too large, may cause permanent motor weakness or even paralysis. The anesthetic technique employed for cordotomies may be a significant factor in determining the outcome of this operation. Under general anesthesia the extent of surgical interruption cannot be tested intraoperatively. Spinal anesthesia may be associated with inadequate levels of surgical anesthesia, especially because the surgical procedure usually involves the upper thoracic and lower cervical dermatomes. In addition, even if an adequate level of surgical anesthesia is obtained, sensory examination of the lower parts of the body is precluded because spinal anesthesia usually provides complete distal neural blockade. Only in patients awake with intact sensory and motor function can the procedure be carried out with accurate interruption of pain pathways while sparing motor function. Therefore, local anesthetic infiltration has been the preferred anesthetic technique in our medical center for many years. The following case report presents another way to provide analgesia for laminectomy and open cordotomy while preserving motor and sensory function of the lower legs.