The anatomical characteristics between the thoracic and lumbar spine are significantly different. Several MRI studies have demonstrated that there is a greater depth of the posterior subarachnoid space. Despite anatomical data, anesthesiologists are reluctant to consider higher levels for spinal anesthesia largely due to direct threats to spinal cord. Several articles published in the literature have demonstrated the safety of performing thoracic puncture for anesthesia. The puncture can be performed with a single puncture with a cut tip or pencil tip, or with the aid of the combined epidural-spinal block. In thoracic puncture, isobaric or hyperbaric anesthetics can be used, with or without opioids. The use of hyperbaric solutions provides a sensitive block of longer duration than the motor block. Thus, it is an excellent indication for outpatient surgery with low doses of local anesthetic and early discharge. Most of these articles report only were transient paresthesia, with no occurrence of definitive neurologic complications. Low doses of local anesthetics for segmental spinal anesthesia have already been performed in different types of surgery and certainly in the future more studies related to this technique will allow greater safety for its performance.
Published Date: 2020-06-08; Received Date: 2020-05-19