The given literature review is devoted to the urgent problem of improving the effectiveness of conservative treatment of patients with coronary heart disease through the use of sympathetic blockade. The authors highlight the. current understanding of the morbid physiology of cardiac angina, in particular, pain syndrome, of the state of analgesia in cardiology. Considered in detail the use of thoracic epidural block in case of coronary heart disease, shows the mechanism of action of epidural blockade, clinical features, its antiischemic effect on the myocardium, the impact on hemodynamic. Also described are the possible side effects and complications of epidural blockade. In conclusion, the authors emphasize the prospect of a wide practical application of regional blockade of local anaesthetics and narcotic analgesics in cardiac patients.