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 Continuous spinal anaesthesia (CSA) is a well-established technique, successfully used in many surgical procedures in high-risk patients, allowing careful titration of local anaesthetic drugs with ideal blockage level and minimizing hemodynamic effects. We report using CSA in a patient undergoing left inguinal hernia correction.

Methods A 61-year-old patient, ASA IV, with arterial hypertension, a history of aortic valve replacement surgery four months ago, and severely reduced ejection fraction (EF 20%), was scheduled for elective inguinal hernia correction. Informed consent was obtained. Standard ASA monitoring and invasive arterial blood pressure were instituted. The patient was placed in right lateral decubitus. CSA was performed with an 18G Tuohy needle through a median approach at L3-L4 interspace. Once free flow of cerebrospinal fluid was obtained, an epidural catheter was inserted and the patient was placed in supine. 3.75mg of isobaric bupivacaine was administered, followed by a 1,3mL saline bolus. Surgery began when a sensory block to pinprick at the T10 dermatome was established. The patient experienced discomfort and the block was augmented with 1,8 mg of isobaric bupivacaine. Multimodal analgesia and postoperative nausea and vomiting prophylaxis were completed.

Results The surgery lasted 40 minutes. The patient remained hemodynamically stable throughout, with no need for vasoactive drugs. At the end of surgery, the catheter was removed and the patient was transferred to post anaesthesia care unit. There were no reports of post-dural puncture headache.

Conclusions CSA guarantees minimal side-effects and clinical efficacy in individualized patients who are not fitting candidates for general, single-shot spinal or epidural anaesthesia.