Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims Hemodynamic instability during general anesthesia or after neuraxial anesthesia in patients with severe cardiac disease is a major concern. Continuous spinal anesthesia offers the advantage to use lower dose of local anesthetic (LA) and titrate as needed while maintaining hemodynamic stability. In this report, we describe the use of ultra-low-dose continuous subarachnoid block for an urgent hip hemiarthroplasty.

Methods A 87-year-old male patient, ASA physical status IV, with hypertension, diabetes mellitus, hypercholesterolemia, severe peripheral arterial disease, symptomatic severe aortic stenosis (valvular area 0,72cm2) and disseminated prostate cancer. He was proposed to urgent hip hemiarthroplasty. The patient and his family were informed about the high risk of the procedure and the consent form was obtained. ASA standard monitoring with invasive blood pressure monitoring was established. A catheter was introduced 3 cm in the subarachnoid space with a paramedian approach and 10mcg of fentanyl and 2 mg of isobaric bupivacaine 0,5% were administered through the subarachnoid catheter.

Results The surgery was performed in the left lateral position and lasted 70 minutes without need for further intrathecal administrations. There was requirement for small boluses of ephedrine due to progressive blood pressure drop during the procedure. The catheter was removed in the PACU. Postoperatory period was uneventful and the patient was discharged after 4 days.

Conclusions In patients with severe cardiovascular disease, titration of lower doses of LA in continuous subarachnoid block allows a safer procedure.