Epidural anesthesia and analgesia is widely used to manage major abdominal surgery intraoperative as well as postoperative analgesia, but its risks and benefits are uncertain. High risk surgeries are associated with high morbidity and mortality especially in patients with pulmonary dysfunction, hepatic or renal dysfunctions, advancing age and in case of morbid obesity patients. Thoracic epidural analgesia and anesthesia is associated with decreased morbidity in these patients. Thoracic epidural is associated with haemodynamic stability, good pulmonary function, decreased catecholamine response and early extubation and discharge from intensive care unit. It is an important component of fast tracking in high risk cardiac patients. Its use has significantly increased over the past few years and has been used as an adjuvant to general anaesthesiaas well as the sole technique in selected groups of patients. Proper selection of patients for thoracic epidural epidural is mandatory. Timing of epidural catheter insertion and removal should be judiciously selected.In conclusion epidural analgesia as anesthesia in high risk surgery might decrease pulmonary and cardiovascular or renal complications, provide excellent analgesia and allow fast track early extubation and hence lower mortality and morbidity.