Aim To investigate the role of thoracic epidural anesthesia (TEA) and the change of concentration of nitric oxide (NO) and circulating endothelium cell (CEC) in patients with refractory angina pectoris (RAP). Methods 61 patients with RAP were treated with TEA as the main therapy after cessation of nitroglycerin infusion. The clinical effect of TEA was recorded and plasma concentration of NO,endothelin-1 (ET-1) and CEC was investigated before and 14 days after TEA. Results All patients had reduced severity of chest-pain after TEA. The number of leads with ST depression and degree of ST depression decreased significantly after TEA (P<0.05). Plasma concentration of NO increased after the therapy, whereas ET, CEC decreased significantly (P<0.01). Conclusion TEA may be an effective therapeutic approach for patients with refractory angina pectoris, associated with a protective effect for endothelium cells.