Lumbar Hypobaric Spinal Anesthesia Combined With Intermediate Cervical Plexus Block for Upper Abdominal Laparoscopy:...

Area of Science:

• Anesthesiology
• Regional Anesthesia
• Surgical Safety

Background:

• Thoracic spinal anesthesia provides targeted anesthesia for upper abdominal surgery.
• However, thoracic intrathecal access poses significant safety risks, including potential catastrophic complications.

Purpose of the Study:

• To describe a physiology-based alternative to thoracic spinal anesthesia.
• To achieve T3-T4 sensory coverage for upper abdominal surgery without thoracic puncture.

Main Methods:

• A combination of lumbar hypobaric spinal anesthesia and an intermediate cervical plexus block was employed.
• Ultrasound-guided unilateral cervical plexus block and intrathecal injection of hypobaric ropivacaine with dexmedetomidine and dexamethasone at L2-L3 were performed.
• Patient positioning in the sitting position facilitated cephalad anesthetic spread.

Main Results:

• The combined technique successfully provided anesthesia coverage to the T3-T4 dermatomes.
• Respiratory and hemodynamic stability were preserved throughout the procedure.
• A laparoscopic cholecystectomy was completed uneventfully under spontaneous ventilation.

Conclusions:

• This novel anesthesia approach offers a viable and safer alternative to thoracic spinal anesthesia for upper abdominal procedures.
• The technique successfully achieved the desired anesthetic level while maintaining physiological stability and avoiding thoracic puncture.