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Background and Aims Continuous spinal anesthesia (CSA) is particularly useful in lower limbs surgery in patients with cardiovascular and respiratory comorbidities.

Methods A 74-year-old male, BMI 27 Kg/m2, ASA IV status, was scheduled for urgent supragenicular amputation due to critical ischemia of the left lower limb. The patient had a history of type II diabetes mellitus, hypertension, heart failure (ejection fraction of 34%) NYHA lll, atrial fibrillation, recent pulmonary embolism, and COPD. The patient was under anticoagulants, antiarrhythmics, anti-hypertensives, bronchodilators, and oral hypoglycemic agents. Laboratory analysis showed Hb 10.6 g/dL, no coagulation abnormalities (LMWH was stopped for 24 hours) and normal renal function. The patient was alert, eupneic without supplemental oxygen and hemodynamically stable. The patient was proposed for CSA with standard ASA and invasive blood pressure monitoring

Results A Tuohy needle was placed at L3/L4 level and the catheter was inserted 4 cm into the subarachnoid space. One milliliter of bupivacaine 0.5% was administered, achieving a T8 block within 10 minutes; a repeated dose of 0.5 ml was given 45 minutes later. The surgery proceeded without complications. Hemodynamic stability was maintained without the need for vasopressor support. At the end of surgery, 100mcg of morphine was given through the catheter and the intrathecal catheter was removed.

Conclusions In this case, CSA was an effective and safe option for a high-risk surgical patient. The advantage (over single-shot spinal anesthesia) to adjust the level of anesthesia and prolong its duration, with lower doses of local anesthetics, reduced the risk of complications such as hypotension and respiratory depression.