Thoracic segmental spinal anaesthesia using isobaric bupivacaine for total laparoscopic hysterectomy: A retrospective study

Abstract

Background and Aims: Thoracic segmental spinal anaesthesia (TSSA) using isobaric bupivacaine is an emerging technique for abdominal surgeries, offering advantages such as stable haemodynamics, less postoperative pain, and early recovery compared to general anaesthesia. This retrospective study evaluates its feasibility, efficacy, and safety in patients undergoing total laparoscopic hysterectomy (TLH). Methods: This was a single-centre retrospective study conducted at a tertiary care hospital after obtaining ethical clearance. We reviewed electronic medical records of eligible patients who received TSSA for elective TLH between 1 April 2023 and 31 October 2025. Of 78 patients, 12 were excluded due to incomplete records. Block characteristics, feasibility, and safety were analysed in all 66 patients with adequate documentation. Detailed perioperative outcomes were reported for the primary cohort of 50 patients with a body mass index ≤35 kg/m² and standard surgical duration. Results: All 66 patients achieved adequate initial sensory block with 10 mg isobaric bupivacaine + 25 µg fentanyl (onset 4.8 ± 1.1 minutes). The feasibility of completing TLH under TSSA was 64/66 (97.0%). Two patients (3.0%) required conversion to general anaesthesia. In the primary cohort (n = 50), the mean surgical duration was 85 ± 15 minutes. Haemodynamic stability was excellent, with hypotension in 10.6% cases. Complications were low, with no high spinal block or neurological sequelae. Early ambulation and a short hospital stay were observed. Conclusion: TSSA with isobaric bupivacaine appears to be safe and effective for TLH, with low complication rates and excellent haemodynamic control. Prospective studies are warranted to confirm these findings.