THORACIC SEGMENTAL SPINAL ANAESTHESIA IN UPPER ABDOMINAL SURGERIES AND SIMPLE MASTECTOMY-A CASE SERIES

MADHUCHANDA BORAH; KAVERI DAS; BIJOY AHIR; ANJALI VERMA; PYDIMALLA VENKATA GOWTHAM; KARUNA KUMAR DAS; PRITANU DEB BARUAH

doi:10.22159/ijcpr.2024v16i3.4088

Authors

MADHUCHANDA BORAH Department of Anaesthesiology, Assam Medical College and Hospital, Dibrugarh, Assam, India https://orcid.org/0009-0009-9291-6780
KAVERI DAS Department of Anaesthesiology, Assam Medical College and Hospital, Dibrugarh, Assam, India
BIJOY AHIR Department of Anaesthesiology, Assam Medical College and Hospital, Dibrugarh, Assam, India
ANJALI VERMA Department of Anaesthesiology, Assam Medical College and Hospital, Dibrugarh, Assam, India https://orcid.org/0009-0006-9726-9699
PYDIMALLA VENKATA GOWTHAM Department of Anaesthesiology, Assam Medical College and Hospital, Dibrugarh, Assam, India https://orcid.org/0009-0000-5789-3004
KARUNA KUMAR DAS Department of Anaesthesiology, Assam Medical College and Hospital, Dibrugarh, Assam, India
PRITANU DEB BARUAH Department of Anatomy, Assam Medical College and Hospital, Dibrugarh Assam, India https://orcid.org/0009-0008-3106-2294

DOI:

https://doi.org/10.22159/ijcpr.2024v16i3.4088

Keywords:

Thoracic spinal, Upper abdominal surgery, Laparoscopy, Breast surgery

Abstract

Objective: To observe safety and efficacy of Segmental thoracic spinal anesthesia (STSA) in upper abdominal and breast surgeries.

Methods: 14 cases were selected, out of which 6 laparoscopic cholecystectomy (LC), 4 open cholecystectomy (OC), 3 emergency exploratory laparotomy and 1 simple mastectomy. Under full aseptic precaution, segmental thoracic spinal anesthesia was administered through midline approach in T_8-9 space for upper abdominal surgeries and T_5-6 space in a simple mastectomy. Using 25G Quincke spinal needle 1.5 ml [7.5 mg] of 0.5% Isobaric Levobupivacaine mixed with 0.4 ml (20µg) Fentanyl was given in abdominal surgeries and 1.2 ml [6 mg] of 0.5% Isobaric Levobupivacaine mixed with 0.4 ml (20µg) Fentanyl in simple mastectomy.

Results: Age group of patients ranged from 25 to 65 y, Male: Female ratio of 4:10, Body Mass Index (BMI) range of 22 to 24.9 with physiological status of ASA I to ASA III. Hemodynamically, hypotension was observed in every patient after 5-10 min of STSA well managed with fluid and vasopressors with no bradycardia. Average width of sensory block was T₃ to L_1-2in upper abdominal surgeries and T₁to T₈in a simple mastectomy. Motor block was Modified Bromage Scale (MBS) of 0 to 1 during and postoperatively. Regarding analgesia, Visual Analogue Scale (VAS) score was 0 intraoperatively and 0-1 postoperatively. Sedation score was 2 both intraoperatively and postoperatively with no significant complications and good patient and surgeon satisfaction.

Conclusion: Segmental thoracic spinal anaesthesia is a safe and effective procedure with good patient and surgeon satisfaction.

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