The state of the art of thoracic spinal anesthesia. From Jonnesco in the early 20th century to the present day

Over time, the indications for large-scale spinal anesthesia have fluctuated between cycles of popularity and periods of ostracism. Continuous technological advances in the manufacture of needles and catheters, in the synthesis of safer anesthetics, in the knowledge of nociceptive mechanisms, in the introduction of pharmacological adjuvants and in better control over the physiological changes resulting from the technique, have allowed this secular method, characterized by its simplicity, efficiency and safety, to continue to be useful and current in the anesthesiologic arsenal. Most anesthesiologists worldwide use thoracic epidural anesthesia, which has been shown in four studies with 6,609 patients to have an incidence of accidental perforation in 50 patients of (0.75%). However, they are reluctant to consider higher levels for spinal anesthesia because of the possibility of direct spinal cord injury. This article shows that thoracic spinal anesthesia began in the 20th century and has gained numerous followers worldwide in the 21st century, with effectiveness and safety, with no reports of neurological injury. TSA began with CSE for laparoscopic cholecystectomy and was used in several other procedures worldwide. Finally, its safety led several researchers to enthusiastically pursue the technique allowed the study of continuous thoracic spinal anesthesia and other indications such as breast surgery and spinal fractures. More importantly, although the incidence of paresthesia is like lumbar puncture, which was transient and lasted a maximum of three days, the incidence of cardiocirculatory complications is lower than that of lumbar spinal anesthesia and, to date, there have been no reports of serious and permanent neurological complications, even with the catheter within the subarachnoid space. After numerous published studies and all referenced in this Narrative Review, we can conclude that TSA is safe and without complications and that possibly the anatomy of the subarachnoid space that places the spinal cord more anteriorly prevents its injury.