T horacotomy and video-assisted thoracoscopic surgeries (VATS) induce severe postoperative pain and respiratory impairment not commonly seen in other major surgical incisions, contributing significantly to postoperative morbidity. Significant acute postoperative pain after thoracotomy is a predictor of chronic post-thoracotomy pain (CPTP). We present here a review of the literature with regard to the benefits of thoracic epidural analgesia (TEA) and alternatives to neuraxial techniques. The studies outlined demonstrate that TEA remains the "gold standard" for patients with thoracic surgery-related pain. The benefits include a decrease in pulmonary complications, pain scores, and incidence of dysrhythmias.