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Background and Aims Elderly patients with hip fracture and comorbidities are at a high risk to have complications during or after the operation.The mortality rate is sometimes very high.The aim of this case is to accentuate the light on the role of the continuous spinal anesthesia in severe critical ill elderly patients with severe comorbidity and mortality.

Methods A 67 years old female presented with hip fracture.She was having atrial fibrillation,hypertension,2 type diabetes,dyslipidemia.A heart ultrasound showed a severe critical aortic stenosis with a pulmonary hypertension of 62mmhg.The operation was postponed for one week as the patient was on NACO and then shifted to enoxaparin 60 mg twice daily,also she was stented two years ago.A continuous spinal anesthesia via an epidural tuohy needle 16 g with a catheter insertion in the subdural space L3-L4.Isobaric bupivacaine 0.5%-1ml was prepared and given intermittently by 2 mg until the patient didn’t feel the pain on the operative site.A total of 4 mg of isobaric bupivacaine0.5% was given and the hip replacement was done in 40 min.

Results The patient was stable during the operation and after.One episode of hypotension was seen, corrected by phenylephrine 100 mcg iv,dexamethasone 8 mg iv was added also.A minimal infusion of 250 ml of ringer lactate was given.As the patient was hemodynamically stable in the recovery room she was sent to the wards.

Conclusions Continuous spinal anesthesia with minimal doses of isobaric bupivacaine 0.5% for hip fracture replacement in severe critical ill elderly patients may be a good solution.