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Background and Aims General and neuraxial anaesthesia may induce significant hemodynamic instability in frail, high-risk patients. Continuous subarachnoid block (CSB) allows precise titration of local anaesthetics with ideal blockage level and minimal hemodynamic effects. We report using a CBS for an urgent hip fracture repair.

Methods An 89-year-old patient, ASA IV, with severe aortic stenosis, NYHA III heart failure, asthma, and chronic kidney disease presented for urgent hip fracture repair. An informed consent was signed. ASA monitoring was instituted. The patient was placed in right lateral decubitus, and CSB was performed through a median approach using an 18G Tuohy needle at L3-L4 interspace. Once free flow of cerebrospinal fluid was identified, an epidural catheter was introduced, and the patient was placed supine. 3,5 mg of isobaric bupivacaine 0.5% was administered, followed by a 1,3mL saline bolus. When a sensory block was established at the T8 level, the patient was positioned on a traction table and the surgery began. Multimodal analgesia was completed with ketorolac and paracetamol. Ondansetron was administered as nausea and vomiting prophylaxis.

Results The surgery lasted 45 minutes. Despite administration of a very small dose of anaesthetic, the patient needed 18mg of ephedrine to maintain hemodynamic stability. There was no need for further administration of anaesthetic. At the end of surgery, the catheter was withdrawn; the patient was transferred to post anaesthesia care unit. There were no reports of post-dural puncture headache.

Conclusions Continuous spinal block is very effective for delivering titrated neuraxial anaesthesia with lower doses of local anaesthetic and minimal hemodynamic repercussions.