Effectiveness of Segmental Thoracic Spinal Anaesthesia Versus General Anaesthesia in patients undergoing Modified Radical Mastectomy: A Randomized controlled trial

Breast cancer is one of the most common malignancies affecting women worldwide and remains a major public heal concern. InIndia the incidence of breast cancer is 25.8/1,00,000 population. General anesthesia remains the standard approach for modified radical mastectomy. However, it is associated with higher stress response, post-operative pain, aspiration risk, atelectasis , pneumonia , major adverse cardiac events, longer recovery time, Post Traumatic Stress Disorder.  Regional anesthesia has increasingly gained recognition in recent years. This technique offers several advantages— like reduced surgical stress response, reduced incidence of respiratory and cardiac complications and better pain control, quicker return of bowel function, lower rates of post-operative nausea and vomiting (PONV), reduced risk of thromboembolic events and early patient mobilization. It also provides superior analgesia, and decreased postoperative opioid requirements and better overall patient satisfaction. Advances in anesthesia have played a crucial role in improving patient satisfaction.There is a potential direct inhibitory effect of local anesthetics on cancer cell migration which has encouraged anesthesiologists worldwide to incorporate various regional anesthesia methods into clinical practice .With growing interest in Enhanced Recovery After Surgery (ERAS) protocols and the need to minimize opioid use, Segmental Thoracic Spinal Anaesthesia for modified radical mastectomy presents as a promising approach. However, it requires expertise and also, careful patient selection is essential. Segmental Thoracic Spinal Anaesthesia is a regional anesthesia technique that involves injecting a small volume of local anesthetic into the thoracic subarachnoid space to achieve a targeted and segmental block .This technique allows a more localized anesthesia, minimizing the spread of the block and preserving motor function in unaffected areas, making it a highly targeted and precise form of Anaesthesia .Segmental Thoracic Spinal Anaesthesia offers potential benefits such as stable hemodynamics, reduced postoperative nausea and vomiting(PONV), superior analgesia, quicker recovery and early ambulation and better outcome in terms of peri operative mortality and morbidity compared to general anesthesia. Segmental Thoracic Spinal Anaesthesia is currently being explored as available option for thoracic and upper abdominal procedures. Therefore, we plan to compare the effectiveness of Segmental ThoracicSpinal Anaesthesia and General Anaesthesia in patients undergoing Modified Radical Mastectomy.