Background <p>Acute abdominal pain is an uncommon manifestation of pheochromocytoma. Poor pain management may delay preoperative optimization of hemodynamics and intravascular blood volume. We report a case in which early epidural analgesia facilitated preoperative preparation for a laparoscopic adrenalectomy.</p> Case presentation <p>A female patient diagnosed with pheochromocytoma developed the sudden onset of severe left lower abdominal pain, hypertension, nausea, and vomiting. Pain treatment with acetaminophen and loxoprofen was insufficient, and opioids were avoided due to persistent nausea and constipation. Initiation of continuous thoracic epidural analgesia with 0.25% levobupivacaine resulted in rapid pain relief and improved gastrointestinal symptoms. Over a 9-day period, blood pressure and intravascular blood volume were optimized while epidural analgesia was continued. She underwent a successful adrenalectomy and was discharged without complications.</p> Conclusions <p>This case illustrates the potential utility of early epidural analgesia in the preoperative management of pheochromocytoma, particularly in patients with refractory abdominal pain and limited opioid tolerance.</p>