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Background and Aims Continuous spinal anaesthesia (CSA) is a seldom used anaesthetic technique. Advantages of CSA over other neuraxial anesthesia techniques include its ability to maintain anaesthesia for prolonged periods by administering low, incremental and titrated doses of local anaesthetic, reducing haemodynamic instability while providing a fast and dense block.

Methods A 65-year-old male patient, ASA IV, was admitted for closed reduction and osteosynthesis of a pertrochanteric femoral fracture. Relevant medical history included severe aortic stenosis, coronary artery disease, cardiac pacemaker, chronic kidney disease undergoing hemodialysis, insulin- treated diabetes, hypertension, and obstructive sleep apnea on CPAP. Furthermore, the patient had previously undergone a maxillectomy and subsequent reconstruction, resulting in a severely restricted mouth opening. Considering the patients comorbidities, predicted difficult airway and surgical procedure, CSA was elected as the anaesthetic technique.

Results Standard ASA monitoring with invasive blood pressure evaluation was used, and a preemptive strategy formulated for potential difficult airway management. An epidural needle was used to detect the subarachnoid space (SAS) in the L4-L5 interspace. A catheter was left 3cm inside the SAS and 5mg (1ml) of 0,5% levobupivacaine and 2,5mcg (0,5ml) of sufentanil were injected intrathecally as the initial loading dose. Subsequent doses of levobupivacaine were titrated as needed. At the end of surgery the catheter was removed and a femoral block with 15ml of 0.25% levobupivacaine performed. The procedure was uneventful, hemodynamic stability was maintained and airway manipulation avoided.

Conclusions CSA is an effective and adequate technique for frail patients who benefit from avoiding general anesthesia and demand a more rigorous hemodynamic control.

Attachment PatientconsentCSA.pdf