Spinal anaesthesia has several advantages compared with general anaesthesia. This is because spinal anaesthesia has little effect on respiration and cardiac complications, the avoidance of airway instrumentation and its potential complications, can suppress the neuroendocrine response from surgery, adequately managed acute postoperative pain, earlier recovery of gastrointestinal function, less effect of postoperative nausea and vomiting, earlier ambulation and discharge from hospital, a lower incidence of deep vein thrombosis, lower surgical site infection rates, reduced need for blood transfusions, and reduced costs (Roux et al. 2023).

Thoracic spinal anaesthesia has been performed for a variety of surgical procedures. These include lower limb orthopaedic surgery, abdominal cancer surgery, breast surgery, laparoscopic cholecystectomy, and caesarean delivery. However, no one has reported upper limb orthopaedic surgery under thoracic spinal anaesthesia. This case report shows that thoracic spinal anaesthesia with cervical level (C4) block results good outcome and safe in patients undergoing upper limb surgery. Although this action was avoided by the anaesthesiologists because fear of iatrogenic injury to the spinal cord, cephalad spread of local anaesthetic causing a complete spinal block, and haemodynamic instability owing to blockade of cardioaccelerator sympathetic fibres, but no cases of complete spinal block were identified in the literature where thoracic spinal anaesthesia was performed (Roux et al. 2023; Imbelloni and Gouveia 2014; Kour and Wani 2019; Spannella et al. 2020; Hobaika et al. 2015; Mahmoud et al. 2014; Daszkiewicz et al. 2016; Chauhan et al. 2021).