Background and aims Although general anesthesia is the almost only technique in thoracic spine surgery, it carries high risks of ventilator dependency, unstable hemodynamics and postoperative pain. We aimed to present a case where we applied the bilateral multiple ultrasonography guided MTP blocks for awake thoracic spine surgery.

Methods The written informed consent for both anesthesia and publication was obtained from the patient. a 62-year-old male with a history of hypertension and chronic respiratory disease was planned for surgical treatment of osteoporotic vertebral (T6) collapse fracture with severe pain (VAS>8). a decision was made to perform preoperative MTP blocks to provide some immediate relief during preparation of patient. After identification of the midpoint between the transverse process and pleura, MTP blocks were performed bilaterally at T3, T5 and T7 using parasagittal scan and in-plane needle insertion caudad to cephalad with 55 ml 0,25% bupivacaine and 8 mg of dexamethasone (9 ml for each level).

Results After 30 minutes, the patient reported that his pain had diminished significantly. Using a pinprick test with a 22-G needle, we determined in the T2-T8 dermatomes that were completely anesthetized. Considering the patient‘s prior history and comorbidities, we attempt to perform surgery under regional anesthesia. After all preparations (LMA, videolarygoscope) for ventilation and possible emergencies in the prone position, posterior transpedicular screw fixation between T4-T8 levels was performed uneventfully. the patient was cooperative, with moderate sedation (Video 1.)

Conclusions In summary, we report the first use of bilateral multiple MTP blocks which provided excellent and complete surgical anesthesia for thoracic spine surgery.