A case series of thoracic segmental spinal anesthesia for elective gynecological laparoscopic surgeries

Introduction: Laparoscopic gynaecological surgeries are typically performed under general anaesthesia. While a few studies have explored the use of spinal anaesthesia for these procedures, they have been limited by issues such as shoulder tip pain. However, with growing interest in using thoracic segmental spinal anaesthesia for laparoscopic abdominal procedures, its potential application in gynaecological procedures can be explored. Due to dearth of literature on the same, we chose to conduct a case series involving 10 patients undergoing elective gynaecological laparoscopic surgeries with thoracic segmental spinal anaesthesia. Our objectives were to assess perioperative hemodynamic stability, the incidence of shoulder tip pain, patient tolerance of vaginal manipulation, and the time to post-operative voiding. Materials and Methods: 10 patients of 18-40 years ASA grade 1 & 2 posted for elective gynaecological laparoscopic surgeries. Exclusion criteria were patients of ASA grade 3-4, patients who had contraindications for spinal anaesthesia, patients with known hypersensitivity to study drugs and patient refusal to participate in the study. Thoracic segmental spinal anaesthesia was attempted with patient sitting position in T9-10 space with 25G Quincke spinal needle and 1.4 ml of isobaric 0.5% levobupivacaine was given. Intraoperative vitals were noted, shoulder tip pain and pain on vaginal manipulation was noted. Postoperative voiding time was noted. Results: We achieved a sensory level of T4-L3 in all patients. Hypotension (>20% fall from baseline) occurred in all patients but could be managed with 6 mg Mephentermine. No patient complained of shoulder tip pain. However, patients did complaint of discomfort on vaginal manipulation which was managed with Injection Ketamine 20 mg. Duration of analgesia was 150-180 min. All patients voided urine spontaneously within 3 hours. Conclusion: Thoracic segmental spinal anaesthesia is an effective technique for gynaecological laparoscopic surgeries providing adequate surgical anaesthesia