Thoracic spinal anesthesia offers targeted anesthesia for upper abdominal surgery but raises safety concerns related to thoracic intrathecal access and potential catastrophic complications. We describe a physiology-based alternative combining lumbar hypobaric spinal anesthesia with an intermediate cervical plexus block to achieve similar coverage to thoracic spinal anesthesia (T3–T4) without thoracic puncture. A 46-year-old woman undergoing laparoscopic cholecystectomy received a unilateral ultrasound-guided cervical plexus block and intrathecal 4 mL hypobaric ropivacaine with dexmedetomidine and dexamethasone at L2–L3. Sitting positioning enabled cephalad spread to T3–T4 while preserving respiratory and hemodynamic stability. Surgery was completed uneventfully under spontaneous ventilation.
Pullano et al. (Fri,) studied this question.