Sparing the Brain, Saving the Breast: Thoracic Segmental Spinal Anesthesia in Frail Geriatric Patients

Thoracic segmental spinal anesthesia (TSSA) provides a selective neuraxial block while preserving spontaneous ventilation and may therefore be useful in frail older patients in whom general anesthesia carries increased cardiorespiratory and neurocognitive risk.We describe three women aged 81, 91, and 99 years (American Society of Anesthesiologists (ASA) physical status III, IV, and III, respectively) who underwent breast quadrantectomy, with sentinel lymph node biopsy in two cases, under TSSA as the sole anesthetic technique.After informed discussion of the individual risks and benefits, spinal anesthesia was performed at the T7-T8 interspace using a 25-gauge Whitacre needle (Becton, Dickinson and Company (BD), Franklin Lakes, New Jersey, USA).Hypobaric ropivacaine was administered at a low dose (7.5 mg in two patients and 6 mg in one), without intrathecal adjuvants or intraoperative sedation.All procedures were completed without conversion to general anesthesia or additional anesthetic supplementation.Spontaneous ventilation was maintained throughout, and no clinically relevant hemodynamic, respiratory, or neurological complications were observed.Lower-limb motor function was preserved at the end of surgery, and scheduled intravenous paracetamol alone provided postoperative analgesia during the first 24 hours.Scores on the Italian-validated Quality of Recovery-15 (QoR-15I) questionnaire remained high at 24 and 48 hours.These cases suggest that low-dose TSSA may be a feasible anesthetic option for selected frail elderly patients undergoing breast surgery.Larger prospective studies are required to better establish its safety, indications, and reproducibility.