Indications and Technique for Thoracic Segmental Spinal Anesthesia in Clinical Practice: A Narrative Review

Thoracic segmental spinal anesthesia (TSSA) represents an advanced technique in present clinical anesthetic practice. By lowering the systemic effects of anesthesia, preserving improved hemodynamic stability, and accelerating postoperative recovery, its targeted approach provides significant benefits in certain upper abdominal and thoracic procedures, particularly in high-risk patients. However, careful patient selection, exact technical execution, and in-depth understanding of thoracic anatomy are necessary for its successful implementation. Despite its advantages, TSSA is not yet widely adopted. The major concerns remain related to its technical complexity, principally the risk of spinal cord injury, and the necessity for specialized training and imaging guidance during needle placement. In recent years, there has been a surge in the number of articles describing the safety of TSSA for varying surgeries. This review aims to summarize various indications and the techniques described in the literature related to TSSA.