Thoracic Segmental Spinal Anesthesia for Bullectomy in a Patient With Severe Pulmonary Compromise: A Case Report

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Regional Anesthesia

Background:

• Conventional general anesthesia with one-lung ventilation poses risks for patients with severe pulmonary disease.
• Thoracic segmental spinal anesthesia (TSSA) with regional techniques is an alternative for high-risk patients.
• Nonintubated thoracic surgery aims to reduce perioperative risks.

Purpose of the Study:

• To evaluate the feasibility of TSSA combined with vagus nerve block for awake thoracic surgery in a high-risk patient.
• To present a case study of a patient with complex comorbidities undergoing awake video-assisted thoracoscopic surgery (VATS).

Main Methods:

• A 76-year-old male patient with spontaneous pneumothorax and compromised respiratory function was selected.
• Low-dose TSSA (T5-T6, 6 mg bupivacaine) and ultrasound-guided cervical vagus nerve block (4 mL 1% lidocaine) were administered.
• The patient underwent awake VATS for wedge resection and mechanical pleurodesis.

Main Results:

• The patient remained awake and hemodynamically stable throughout the procedure.
• Spontaneous ventilation was maintained, and no conversion to general anesthesia was needed.
• Successful surgical outcome with resolution of air leak and no postoperative complications, enabling early discharge.

Conclusions:

• TSSA combined with vagus nerve block is a feasible anesthetic option for carefully selected high-risk patients.
• This approach can be a safe alternative to general anesthesia in awake thoracoscopic surgery.
• Further prospective studies are needed to confirm safety, efficacy, and selection criteria.