Utility of thoracic segmental spinal anaesthesia (TSSA) in high-risk surgical patients – our experience: Twin case report

Thoracic segmental spinal anesthesia (TSSA) is a relatively older technique with renewed interest in recent years due to utilization by an increasing number of anesthesiologists across the globe. It is considered as a suitable alternative to general anesthesia (GA) in surgical patients who are considered as high risk for GA. We discuss our TSSA experience with two of these high-risk surgical patients. The first case was gastric outlet obstruction with severe chronic obstructive pulmonary disease (forced expiratory volume 1 = 30%) with no reversibility and moderate pulmonary hypertension (pulmonary artery pressure = 45 mmHg) posted for gastrojejunostomy belonging to ASA-III. The second case was a huge incisional (ventral) hernia with impending strangulation with recent lower respiratory tract infection (ASA-IIE) for laparotomy and meshplasty. Considering these patients’ comorbid conditions and upper abdominal surgery, we planned TSSA with a thoracic epidural for postoperative pain relief. We share our experience of successfully managed two high-risk surgical cases under TSSA and epidural analgesia.