Comment on ‘Thoracic spinal anaesthesia – An effective alternative to general anaesthesia in breast surgeries: A randomised, non-blinded study’

Dear Editor, The authors in their study have compared thoracic spinal anaesthesia (TSA) as an alternative to general anaesthesia (GA) for breast surgeries.[1] This topic is very relevant as TSA is considered a suitable option for patients at high risk for GA. As we explore TSA versus GA in healthy adults, we must approach the study with a rigorous and thorough scientific method. In the current study, patients in the GA group received only short-acting fentanyl at induction, unlike the standard recommendation of multimodal analgesia.[2] Patients in the TSA group received spinal levobupivaine. The difference in time to first rescue analgesic (primary objective) is obvious but not factual, and hence it is irrelevant. Secondly, the methodology mentions that the reasons for patient dissatisfaction were analysed; however, this data has not been elaborated upon in the results.[1] It is known that awake patients during surgery might find theatre environment stressful and unpleasant and often request to be knocked off in the absence of any high risk.[3] Was the higher dissatisfaction in the GA group in this study related to inadequate pain relief? Lastly, the authors have commented that no complications of TSA were noted in this trial.[1] A note to the effect that the sample size (30 patients) was not powered to comment on procedural-related complications is vital. It is essential to share with all young readers that TSA is a procedure that can be associated with potentially morbid complications and must be carried out only by an experienced anaesthesiologist well versed with lumbar spinals and thoracic epidural anaesthesia.[4] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Disclosure of use of artificial intelligence (AI)-assistive or generative tools The AI tools or language models (LLM) have not been utilised in the manuscript, except that software has been used for grammar corrections and references.