Role of Thoracic Spinal Anaesthesia in Modern Practice – A Critical Review

Thoracic spinal anaesthesia (TSA) is gaining increasing recognition as a valuable regional anaesthetic technique in modern surgical practice, particularly for patients who are at high risk for complications associated with general anaesthesia. With the growing volume and complexity of surgical procedures worldwide, the demand for safer, targeted anaesthetic approaches has expanded. TSA involves intrathecal injection of local anaesthetic agents at thoracic vertebral levels, producing segmental sensory, motor, and sympathetic blockade suitable for a range of surgical interventions. Advances in anatomical knowledge and imaging modalities, especially MRI and ultrasound guidance, have improved the safety profile of this technique. Studies demonstrate a relatively wider posterior cerebrospinal fluid space in the thoracic region, offering a protective margin during needle placement. Although technical challenges exist due to narrow interlaminar spaces and angulated spinous processes, refined approaches such as paramedian insertion and optimal patient positioning enhance procedural success. Compared with general and lumbar spinal anaesthesia, TSA offers several advantages, including reduced cardiopulmonary complications, improved perioperative analgesia, attenuated surgical stress response, earlier return of gastrointestinal function, decreased postoperative nausea and vomiting, and shorter hospital stay. The use of lower doses of local anaesthetic also contributes to greater haemodynamic stability. TSA has been successfully employed in breast surgery, abdominal cancer procedures, laparoscopic cholecystectomy, nephrectomy, and selected thoracic surgeries, particularly in elderly and high-risk patients with compromised pulmonary function. Despite its benefits, potential complications such as hypotension, bradycardia, post-dural puncture headache, neurological injury, and infection must be considered. Careful patient selection, adherence to contraindications, and informed consent remain essential. Overall, TSA represents a safe and effective alternative anaesthetic modality with expanding clinical applications.