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Background and Aims Literature on thoracic spinal anaesthesia (TSA) for breast surgery is scarce. The present series explored block characteristics and outcomes in the patient undergoing Modified Radical Mastectomy (MRM) under TSA in female patients with ASA I-III physical status.

Methods 20 patients underwent unilateral MRM. TSA was given with 0.75% isobaric ropivacaine (1ml), fentanyl (25 μg) and dexmedetomidine (10 μg) at T4- T5 space. All patients received IM glycopyrrolate and IV ondansetron pre-operatively, pre-loaded with IV RL @10ml/kg. fentanyl sedation @1mcg/kg IV in divided doses. Intra-operative hemodynamics, block characteristics, intraoperative complications, pain score and analgesic consumption, postoperative adverse effects, and patient satisfaction with were studied

Results TSA was performed easily in all the patients, including two patients who complained of paraesthesia. The TSA was effective for surgery in all 19 patients. 4 patients had intra-operative apnoea with only one patient requiring bag and mask ventilation but none requiring conversion to general anaesthesia. 6 patients required mephentermine more than the median dose i.e. 12mg IV. One patient had hypotension with tachycardia and 2 patients had intraoperative bradycardia none required IV atropine. Recovery was uneventful, only 3 patients had complaints of PONV and only 2 patients required IV tramadol (50mg). 16 patients were satisfied with the anaesthesia technique and 3 patients were dissatisfied.

Conclusions This feasibility study has shown that TSA can be used successfully and effectively for MRM surgery. However, the use of anaesthetic techniques requires experience and great caution.