Two cases of thoracic spinal anaesthesia in patients with severe diseases

Safety and Efficacy of Ultrasound-Guided Combined Segmental Thoracic Spinal Epidural Anesthesia in Abdominal Surgeries and Laparoscopic Procedures: A Prospective Randomized Clinical Study

Background

Thoracic segmental spinal anesthesia (SA) may be a good alternative to general anesthesia (GA) for abdominal operations and laparoscopic procedures, especially in high-risk patients.

Objectives

The aim of this study was to investigate the safety and efficacy of thoracic segmental SA vs GA during abdominal operations and laparoscopic procedures.

Methods

This study was conducted at our university hospital and involved a total of 46 patients who underwent abdominal operations and laparoscopic procedures. The study period spanned from January 15, 2022, to October 15, 2022. Patients were divided into 2 groups: Group 1 (n = 23) received standard GA, and group 2 (n = 23) received thoracic segmental SA. A combination of 10 mg of hyperbaric bupivacaine 0.5% and 25 μg of fentanyl was injected through the spinal needle. The epidural catheter was then threaded through the Tuohy needle after withdrawal of the spinal needle to keep only 4 cm up in the epidural space. Demographic data, both intra and postoperative hemodynamic parameters, were monitored. Postoperatively, pain in both groups was treated with intravenous (IV) morphine by patient controlled analgesia (PCA), PCA settings were 1 mg morphine/mL, no background infusion, bolus dose 2 mL and lockout interval 15 min. Postoperative, both resting VAS and VAS during cough were measured for all patients at fixed intervals, and all patients were followed up for postoperative complications.

Results

No significant variation was found in demographic data. Intra and postoperative mean arterial pressure (MAP) and heart rate (HR) measurements were higher in group 1 than in group 2 but without a statistically significant difference (P < 0.029). Early postoperative VAS values and discharge time from the postanesthesia care unit (PACU) were significantly reduced in group 2 than in group 1 (P < 0.001). The number of patients asked for analgesia and total opioid consumption were substantially reduced in group 2 than in group 1. Also, the time of the first analgesia request and patient satisfaction were substantially greater in group 2 than in group 1.

Conclusions

Combined thoracic spinal/epidural block results in stable hemodynamics, longer postoperative analgesia with fewer side effects, and greater surgeon and patient satisfaction in patients undergoing abdominal operations and laparoscopic procedures.

Defining the role of thoracic spinal anaesthesia in the 21st century: a narrative review

Since the performance of the first thoracic spinal anaesthetic in early 1908 many anaesthetists have gained interest in this unorthodox neuraxial anaesthetic technique. The main rationale justifying its use is to prevent complications related to general anaesthesia in high-risk patient populations. There is, however, significant debate regarding this practice around the world. The main concerns are fear of iatrogenic injury to the spinal cord, cephalad spread of local anaesthetic causing a complete spinal block, and haemodynamic instability owing to blockade of cardioaccelerator sympathetic fibres. The purpose of this narrative review is to appraise the literature critically regarding thoracic spinal anaesthesia, to synthesise the available information, and to provide a summary of evidence justifying its use in modern anaesthesia.

Thoracic Segmental Spinal Anesthesia for Emergency Cholecystectomy: A Case Report

Anesthesia is a rapidly evolving medical specialty, centered around the patient's safety, and enhancement of surgical outcomes. In their daily practice, anesthesiologists encounter complex challenges, and always search for, and practice the best evidence-based medicine, which allows them to overcome the challenges, and to obtain the maximum benefits of the intervention, with minimal side effects. Regional anesthesia is considered a favorable modality with significant potential in selected patients and is becoming more popular day by day. In this regard, we present a case report of a 65-year-old man, with multiple co-morbidities, who needed urgent surgery to remove a gangrenous gall bladder. After discussion with the surgical colleagues, thoracic segmental spinal anesthesia (SA) was performed, and the patient underwent an open cholecystectomy awake with spontaneous respiration. The procedure went well, and the patient recovered quickly. This case presentation highlights the potential benefits of segmental SA in managing some selected cases.