Segmental Thoracic Spinal Anesthesia for Critical Patients Undergoing Abdominal Surgeries: A Case Series and Literature Review

Segmental thoracic spinal anesthesia (STSA) is emerging as a promising alternative for high-risk patients undergoing abdominal surgeries, particularly those who are not optimal candidates for general anesthesia (GA). By selectively targeting the thoracic spinal segments responsible for abdominal innervation, STSA aims to provide precise anesthesia and pain management while minimizing systemic side effects. This case series presents the outcomes of several critical patients who underwent abdominal surgeries under STSA. All patients who were considered at high risk for GA and underwent abdominal surgeries under STSA from January to June 2023 were involved in this study. Data regarding patient characteristics, surgical procedures, anesthetic outcomes, complications, and postoperative recovery were extracted and analyzed. The case series includes four patients, three of them underwent laparoscopic cholecystectomy and one underwent laparotomy. The results consistently demonstrated that STSA provided effective surgical anesthesia and muscle relaxation comparable to GA, with a better hemodynamic profile and a lower risk of systemic complications. Moreover, STSA exhibited a favorable postoperative recovery profile, including early ambulation, decreased opioid consumption, and improved patient satisfaction. The evidence suggests that STSA can enhance postoperative recovery and patient satisfaction. However, further research, including larger prospective studies and long-term follow-up, is warranted to establish its efficacy and safety more conclusively. STSA has the potential to become a valuable addition to the armamentarium of anesthesia techniques for abdominal surgeries, optimizing patient outcomes and improving the overall quality of care in this setting.