Since the performance of the first thoracic spinal anesthetic in early 1908 by Thomas Jonnesco in Romania, many anesthetists have gained interest in this unorthodox neuraxial anesthetic technique.

The main rationale justifying its use is to prevent complications related to general anesthesia in high-risk patient populations.

There is, however, significant debate regarding this practice around the world.

The main concerns are fear of iatrogenic injury to the spinal cord, cephalad spread of local anesthetic causing a complete block, and hemodynamic instability owing to blockade of cardioaccelerator sympathetic fibres.

The purpose of this narrative review is to appraise the literature critically regarding thoracic spinal anesthesia and to synthesise the available information to provide a summary of evidence justifying its use in modern anesthesia.

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