Background and Aims Severe pulmonary conditions in patients undergoing surgery place them at greater risk of adverse outcomes and alternatives to general anaesthesia may be encouraged. Prone spinal surgery is customarily performed under GA. We describe the use of regional anaesthesia techniques to successfully circumvent post-operative pulmonary events in a patient with advanced disseminated lung cancer.

Methods A 63-year-old man, ASA IV, with debilitating stage IV lung cancer with pleural and mediastinic involvement, pulmonary artery invasion and adrenal, cerebellum and lumbar vertebrae metastatic disease, presents with severe disabling pain, in need for spinal surgery due to vertebral pathological fracture. After obtaining patient’s consent, an ultrasound-guided bilateral erector spinae block at L2 level (with ropivacaine and dexamethasone) and a spinal blockade (with hyperbaric bupivacaine and sufentanil) were performed. IV infusions of low-dose propofol, ketamine and lidocaine were maintained during surgery.

Results Patient underwent uneventful L2 vertebroplasty and L1-L3 spinal fusion instrumentation. Quality and extension of the block were adequate and allowed surgery. Patient was comfortable during and after the procedure and safely discharged from anesthesia care. Injury-related pain got manageable, and patient was satisfied with the approach. No postoperative complications were observed.

Conclusions In addition to several other reasons like decreased blood loss, less postoperative nausea and vomiting and better pain control comparing with GA¹, regional anaesthetic strategies appear to be useful alternatives for spinal surgery – including instrumented procedures – in patients with important pulmonary comorbidities, namely late stage lung cancer, who are at substantial risk for postoperative complications, avoiding further respiratory compromise in these frail patients.