Intrathecal and epidural analgesia.

Centroneuraxis analgesia has a place in the management of critically ill patients. With the safety of the intrathecally placed microcatheter now in question, epidural blockade is more suitable in the intensive care unit setting. The different mechanisms of action and the resultant synergy of local anesthetic agents and opioids, as well as their different side effects, are outlined. The contraindications to neuraxial blockade are discussed, and the role of epidural analgesia in the management of flail chest syndrome is addressed in detail.