Comparative evaluation of segmental spinal anaesthesia with conventional spinal anaesthesia in endoscopic...

Lumbar spinal anaesthesia (LSA) for endoscopic urological procedures often causes extensive sympathetic blockade, leading to hypotension, bradycardia, and delayed ambulation. Thoracic segmental spinal anaesthesia (TSSA) offers targeted sensory blockades with limited motor involvement and improved haemodynamic stability. The primary objective of the study was to compare motor block onset between TSSA and LSA. Secondary objectives included sensory block characteristics, two-segment regression time, haemodynamics, perioperative complications, and patient and surgeon satisfaction.

Forty American Society of Anesthesiologists (ASA) class I-II patients were randomised to group T (TSSA, n = 20; 1 mL 0.5% isobaric ropivacaine + 20 µg fentanyl at T11-T12) or group S (LSA, n = 20; 2 mL 0.5% hyperbaric ropivacaine + 20 µg fentanyl at L3-L4). Sensory and motor block, haemodynamic parameters, rescue analgesia, satisfaction scores, and adverse events were recorded.

Group T achieved faster sensory block to T10 (1.7 ± 1.08 vs 4.48 ± 1.97 min, P < 0.001), quicker maximum block height (3.42 ± 1.46 vs 8.95 ± 3.3 min, P < 0.001), and shorter two-segment regression (58 ± 6.5 vs 88.77 ± 7.73 min, P < 0.001). Motor block onset was similar (6.6 ± 2.96 vs 5.8 ± 1.67 in groups T and S, respectively), but group S had higher Bromage scores and prolonged blockade (time to Bromage score 0: 61.85 ± 26.37 vs 184.21 ± 30.06 min, P < 0.001). Group S showed greater heart rate and mean arterial pressure reductions (P < 0.05). Patients in Group T ambulated earlier than group S (152.25 ± 29.76 vs 284 ± 26.04 min; P < 0.001).

TSSA provides less motor blockade, targeted sensory block, maintains haemodynamic stability, and enables earlier ambulation, making it a safe and effective alternative in endoscopic urological surgery.