Comparison of thoracic vs lumbar spinal anaesthesia fo orthopaedic surgeries

Abstract

Background: Thoracic spinal anaesthesia has emerged as one of the most promising anaesthetic techniques in the recent times. On the other hand, lumbar approach has been the conventional choice for orthopaedic surgeries since the advent of spinal anaesthesia. This study aimed at determining which approach is better suited for orthopaedic surgeries.Methods: Total 60 patients scheduled for orthopaedic surgeries were divided into two groups : group T and group L. Group T patients were given thoracic spinal anaesthesia at the T9-T10 / T10-T11 interspace using 1.5 ml of hyperbaric bupivacaine 0.5% (5 mg/ml) + 25µg (0.5 ml) of fentanyl. Group L patients received 2.5 ml of hyperbaric bupivacaine 0.5% (5 mg/ml) + 25 µg (0.5 ml) of fentanyl at LI-L2/L2-L3 interspace. Authors evaluated the degree of analgesia and motor block, haemodynamics and neurological complications.Results: Onset of analgesia was faster in thoracic group - 2min. The duration of sensory and motor block was shorter in thoracic group. There were no significant differences in haemodynamic variables and respiratory parameters between the two groups and no neurological complication in any patient.Conclusions: Thoracic spinal anaesthesia is preferable to lumbar spinal anaesthesia for orthopaedic surgeries.

Thoracic spinal anaesthesia for paediatric upper extremity surgery in limited-resource hospital: a case report

“…This case report shows that thoracic spinal anaesthesia with cervical level (C4) block results good outcome and safe in patients undergoing upper limb surgery. Although this action was avoided by the anaesthesiologists because 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, but no cases of complete spinal block were identified in the literature where thoracic spinal anaesthesia was performed (Roux et al 2023;Imbelloni and Gouveia 2014;Kour and Wani 2019;Spannella et al 2020;Hobaika et al 2015;Mahmoud et al 2014;Daszkiewicz et al 2016;Chauhan et al 2021).…”

Thoracic Spinal Anesthesia for Laparoscopic Cholecystectomy: An Observational Feasibility Study

“…Subarachnoid myelography by neurologists in past was performed by utilizing cervical and thoracic punctures of subarachnoid spaces [ 3 ]. However, the thoracic approach has been proven as an effective and feasible method for various thoracic, abdominal, and lower limb surgeries with an acceptable safety profile [ 4 ]. Mahmoud et al used spinal anesthesia at T10 thoracic level for successfully conducting breast surgeries; however the incidence of hemodynamic instability was observed to be 16% [ 5 ].…”