Thoracic epidural analgesia for type B aortic dissection

Sir, Acute type B aortic dissection (ABAD) is a life-threatening vascular emergency with an incidence estimated at 5-30 per 1 million people per year.[1] Available evidence support endovascular and surgical treatment for ABAD complicated by shock or organ damage. In uncomplicated ABAD, benefits of endovascular treatment are not well established and the preferred management mandates close clinical and imaging monitoring and treatment of elevated arterial blood pressure (ABP) and pain.[1,2] We report on a patient with ABAD in whom, in contrast to standard therapy, epidural clonidine was highly effective in controlling elevated ABP and pain. Although epidural clonidine has been employed in different clinical settings, this is, to our knowledge, the first report on its use in ABAD.