Comfortably Numb

- The Battle of the blocks – thoracic epidural vs the others

22^nd October 2026, 19:00 to 20:00 BST

Overview

Optimal analgesia is central to recovery following thoracic surgery and chest wall trauma. While thoracic epidural analgesia has long been regarded as the gold standard, newer regional techniques—including paravertebral, erector spinae plane, serratus anterior plane and intercostal nerve blocks—are increasingly being adopted in both thoracic surgery and rib fracture management. Recent studies have challenged traditional practice, demonstrating comparable outcomes between several regional techniques and epidurals following minimally invasive thoracic procedures, while epidurals may still offer advantages for selected thoracotomy patients.

This webinar will explore the latest evidence, controversies and practical considerations surrounding thoracic analgesia, bringing together surgeons, anaesthetists and trauma specialists to discuss how best to tailor analgesic strategies for thoracotomy, VATS, robotic surgery and rib fractures.

In 2026, is the thoracic epidural still the gold standard—or simply one block among many?

Aims

To review the role of effective analgesia in improving outcomes following thoracic surgery and rib fractures.
To examine the evolving evidence comparing thoracic epidural analgesia with paravertebral, erector spinae plane, serratus anterior plane and intercostal nerve blocks.
To explore the benefits, limitations and complications associated with different regional analgesic techniques.
To discuss how minimally invasive surgery, ERAS pathways and opioid-sparing strategies are influencing analgesic practice in thoracic surgery.
To understand the role of regional anaesthesia in the management of chest wall trauma and multiple rib fractures.
To provide thoracic surgeons, trainees, anaesthetists and trauma clinicians with an evidence-based framework for selecting the optimal analgesic technique for individual patients.
To debate whether thoracic epidural analgesia remains the gold standard in 2026 or whether newer regional techniques should now be considered first-line in selected patient groups.

Learning Objectives

By the end of this webinar, attendees should be able to:

Describe the physiological impact of pain on respiratory function, postoperative recovery, and outcomes following thoracic surgery and rib fractures.
Compare the mechanisms, indications, advantages and limitations of thoracic epidural analgesia, paravertebral blocks, erector spinae plane blocks, serratus anterior plane blocks and intercostal nerve blocks.
Interpret the current evidence comparing thoracic epidural analgesia with alternative regional techniques in thoracotomy, VATS and robotic thoracic surgery.
Discuss the role of regional anaesthesia within Enhanced Recovery After Surgery (ERAS) pathways and opioid-sparing perioperative care.
Recognise the indications for regional analgesic techniques in patients with chest wall trauma and multiple rib fractures.
Select an appropriate analgesic strategy based on patient factors, surgical approach and institutional resources.
Critically appraise whether thoracic epidural analgesia remains the gold standard for thoracic analgesia in contemporary practice.

Panellists

Our panellists include:

Dr Steve Coppens, MD, PhD, ESRA-DRA

Consultant Anaesthesiologist at University Hospitals Leuven (UZ Leuven), Belgium, and Head of the Regional Anaesthesia Fellowship Programme. His clinical and academic practice focuses on regional anaesthesia, perioperative analgesia, and the development and evaluation of innovative analgesic techniques for abdominal and thoracic surgery. He completed his PhD in 2025 investigating novel approaches to perioperative pain management and has authored more than 60 peer-reviewed publications and book chapters. Dr Coppens is an Associate Editor for Regional Anesthesia and Pain Medicine, Journal of Clinical Anesthesia, and the British Journal of Anaesthesia, and serves on the Council and Scientific and Educational Committees of the European Society of Regional Anaesthesia and Pain Therapy (ESRA). An internationally recognised educator and speaker, he is regularly invited to teach and lecture at major national and international meetings, including ESRA, ESAIC, ASA, RA-UK and NYSORA. His research, educational leadership and extensive experience in thoracic and regional analgesia have established him as a leading voice in contemporary perioperative pain management.

Dr H. Bernhard Heidemann FRCA FFPMRCA MEWI

Dr H. Bernhard Heidemann is a consultant anaesthetist with longstanding clinical and educational interests in thoracic anaesthesia, anaesthesia for head and neck cancer surgery, obstetric anaesthesia and neuraxial techniques.

He was a consultant anaesthetist at the Royal Infirmary of Edinburgh from 2003 until his retirement from substantive NHS practice in 2023. During this time, thoracic anaesthesia was a regular part of his clinical practice. He also held senior leadership roles as Clinical Director for Anaesthesia and Theatres at the Royal Infirmary of Edinburgh and Clinical Director for Pain Medicine for NHS Lothian.

Bernhard remains clinically active on a part-time basis and has a strong commitment to postgraduate education. He teaches on the South East of Scotland Final FRCA Viva Course and contributes to thoracic anaesthesia teaching on the regional Final FRCA course.

He has been an instructor on the Advanced Life Support Group’s mMOET course for more than 20 years and is a course director for both mMOET and POET, as well as a member of the POET Working Group. He contributed the chapter on anaesthetic emergencies to the fourth edition of the mMOET manual.

CPD

1 Hour

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Recording

A recording of the webinar will be made available on this page in the days following the live broadcast.