Thoracic Spinal Anesthesia for Laparoscopic Cholecystectomy: An Observational Feasibility Study

The expanding horizons of the application of Segmental Thoracic Spinal anesthesia in day-to-day anesthesia practice prompted us to perform this study in a large subset of healthy patients with the aim of determining the feasibility, safety, advantages, and complications of this mode of anesthesia.

The prospective observational study was conducted from April 2020 to March 2022, 2.146 patients with symptoms of cholelithiasis and planned for laparoscopic cholecystectomy were included in this study, and 44 patients from this study were excluded due to pre-defined exclusion criteria. The patients belonging to ASA lIl, lV, severe cardiovascular or renal disability, on beta blockers, coagulation anomaly, spinal deformities, or previous spine surgeries were not included in the study. The patients exhibiting allergy to local anesthetics, requiring more than two attempts for the procedure, patchy or inadequate effects after spinal anesthesia, or change in the plan of surgery intraoperatively were also excluded from the study. All other patients were given subarachnoid block at T10-T11 intervertebral space with 26G Quincke needle and Inj. Bupivacaine Heavy (0.5%) 2.4 mL with 5µg of Dexmedetomidine. Intraoperative parameters, number of attempts, the incidence of paresthesia during the procedure intraoperative and postoperative complications, and patient satisfaction were evaluated and recorded.

Spinal anesthesia was successful in 2,074 patients and was achieved in a single attempt of procedure in 92% of patients. The incidence of paresthesia during needle insertion was 5.8%. Hypotension was observed in 18% of patients, bradycardia (13%), and nausea (10%) in a few patients, with shoulder tip pain in only 6% of patients. The majority of patients (94%) were "very satisfied" with the procedure. There were no episodes of any adverse event during the postoperative period.

Thoracic spinal anesthesia is a regional anesthesia technique practically feasible for healthy patients undergoing laparoscopic cholecystectomy with a manageable incidence of intraoperative complications and no evidence of any neurological complications. It has the advantage of providing manageable hemodynamics, minimal postoperative complication, and an acceptable degree of patient satisfaction.