Thoracic Segmental Spinal Anaesthesia for Modified Radical Mastectomy: A Case Report

Thoracic Segmental Spinal Anaesthesia (TSSA) serves as a safe and effective alternative to general anaesthesia in high-risk patients with respiratory comorbidities such as Chronic Obstructive Pulmonary Disease (COPD). By avoiding airway instrumentation, the respiratory complications of general anaesthesia, TSSA can be a viable alternative to general anaesthesia in patients undergoing surgeries like modified radical mastectomy. This case report describes a 72-year-old female with very severe COPD posted for modified radical mastectomy for infiltrating ductal carcinoma. Breast surgeries are usually conducted under general anaesthesia. However, general anaesthesia comes with various complications which include higher stress response, nausea and vomiting, inadequate analgesia, postoperative cognitive dysfunction and delirium, and increased length of hospitalisation. In critically ill patients, these complications can prove difficult to handle. An appropriate choice of regional anaesthesia technique can help alleviate some of these issues. One of these techniques includes TSSA. Due to her American Society of Anaesthesiologists (ASA) III status and high risk for pulmonary complications under general anaesthesia, TSSA was chosen. This is because it provides better clinical outcome especially in elderly and frail patients. As we were faced with a high-risk patient who was prone for multiple postoperative complications, an innovative mode of regional anaesthesia was used to overcome complications associated with general anaesthesia. The surgery was uneventful and completed without respiratory or haemodynamic compromise. Postoperative period was uneventful and patient was discharged on postoperative day 5. TSSA proved a safe, effective alternative to general anaesthesia, avoiding airway instrumentation and mitigating major perioperative risks in this high-risk patient.