Lumbar Hypobaric Spinal Anesthesia Combined With Intermediate Cervical Plexus Block for Upper Abdominal Laparoscopy: A Case Report.

Thoracic spinal anesthesia offers targeted anesthesia for upper abdominal surgery but raises safety concerns related to thoracic intrathecal access and potential catastrophic complications. We describe a physiology-based alternative combining lumbar hypobaric spinal anesthesia with an intermediate cervical plexus block to achieve similar coverage to thoracic spinal anesthesia (T3-T4) without thoracic puncture. A 46-year-old woman undergoing laparoscopic cholecystectomy received a unilateral ultrasound-guided cervical plexus block and intrathecal 4 mL hypobaric ropivacaine with dexmedetomidine and dexamethasone at L2-L3. Sitting positioning enabled cephalad spread to T3-T4 while preserving respiratory and hemodynamic stability. Surgery was completed uneventfully under spontaneous ventilation.