Exploring the feasibility of cervicothoracic spinal anesthesia for head, neck, and upper extremity surgeries

Abstract

Background & objective: General anesthesia (GA) is the established method for upper dorsal region surgery, including head, neck, and upper extremity surgery. Cervicothoracic spinal anesthesia (CSA) is an infrequently performed alternative to GA. This prospective study evaluated the feasibility of CSA for head, neck, and upper extremity surgery.

Methodology: We consecutively enrolled 25 patients scheduled for head, neck, upper extremity, and upper dorsal surgeries between August 2023 and September 2024, at a general hospital in Indonesia. We performed CSA using a paramedian approach in the C7-T1 intervertebral space. We mixed a single injection of hyperbaric bupivacaine with five different cocktail drugs using the barbotage method for use in spinal anesthesia. We evaluated patient characteristics, neuraxial techniques of CSA, and outcomes of the CSA.

Results: Of the 25 patients, 8% required a second attempt at spinal needle insertion into the subarachnoid space. No epidural injection or additional analgesia was administered, and no transition to GA was reported in any case. This study identified complications associated with CSA, including apnea, bradycardia, and hypotension. However, apnea was observed exclusively in the cocktail D group, which received 0.75% hyperbaric bupivacaine (up to 10 mg). CSA exhibited an efficacious block-level with an onset time of just 5.7 ± 1.4 min.

Conclusion: Cervicothoracic spinal anesthesia was successfully and safely performed for head, neck, upper extremity, and upper dorsal surgery. It can serve as an alternative anesthesia for patients at high risk of requiring general anesthesia.

Abbreviations: CSA: Cervicothoracic spinal anesthesia, GA: General anesthesia

Keywords: Cervicothoracic Spinal Anesthesia; Head and Neck Surgery; Upper Extremity Surgery; Upper Dorsal Surgery; Regional Anesthesia; Feasibility Study

Citation: Prima A, Subhan N, Tanhar D. Exploring the feasibility of cervicothoracic spinal anesthesia for head, neck, and upper extremity surgeries. Anaesth. pain intensive care 2025;29(6):553-558; DOI: 10.35975/apic.v29i6.2914

Received: June 10, 2025; Revised: July 20, 2024; Accepted: July 24, 2025