Thoracic segmental spinal anesthesia in laparoscopic cholecystectomy: A case series

Laparoscopic cholecystectomy traditionally requires general anesthesia (GA) to manage pneumoperitoneum-induced respiratory compromise. Thoracic segmental spinal anesthesia (TSSA) is an adaptation of the traditional subarachnoid block performed at the thoracic level which can be an alternative to GA. However, the potential for hypercapnia from insufflation and the extent of thoracic fiber blockade after TSSA has not been assessed during laparoscopic procedures. No studies have systematically evaluated arterial blood gas (ABG) parameters during laparoscopic cholecystectomy under TSSA. This study aimed to assess PaCO₂ changes, respiratory compensation, and clinical safety of TSSA in 15 patients undergoing laparoscopic cholecystectomy. Seven patients (46.7%) demonstrated PaCO₂ increase of ≥10 mmHg. Despite these elevations, all patients maintained PaCO₂ <55 mmHg and pH >7.25, with no clinical signs of hypercapnia or respiratory distress. PaO₂ remained >160 mmHg in all patients. Sensory blockade onset occurred at 76 ± 15 s, achieving T4-T5 to T12 dermatomal coverage with preserved lower limb motor function (Bromage score 1). No postoperative complications occurred. Median patient and surgeon satisfaction scores were 5 (IQR 4–5). TSSA with ABG monitoring demonstrated physiological safety and clinical feasibility for laparoscopic cholecystectomy in ASA I-II patients. Despite predictable pneumoperitoneum-induced hypercapnia, all patients compensated effectively without respiratory compromise, supporting TSSA as a viable alternative to general anesthesia in selected cases. Larger randomized controlled trials are warranted.