Thoracic Segmental Spinal Anesthesia for Awake Video-assisted Thoracoscopic Surgery: A Case Report

Awake video-assisted thoracic surgery (VATS) using thoracic spinal anesthesia is a promising alternative to traditional general anesthesia, especially for patients with comorbidities. We report a case of a 72-year-old male with diabetes, hypertension, and coronary artery disease who underwent successful awake VATS for massive pleural effusion. A single-shot T6-T7 spinal injection with isobaric bupivacaine and fentanyl provided effective sensory blockade (T1-T10) without additional sedatives. The procedure was well tolerated, with no complications. Thoracic spinal anesthesia offers simplicity, rapid onset, and the avoidance of intubation-related risks, making it a viable option for selected patients.