Ultra-low dose continuous spinal anesthesia for major orthogeriatric surgery in a high cardiovascular risk patient on chronic aspirin therapy: A case report

We present the case of a 78-year-old man (ASA III), with chronic ischemic heart disease, moderate aortic stenosis, hypertension, diabetes, and renal failure undergoing a second revision hip arthroplasty. Continuous spinal anesthesia (CSA) was performed using an ultra-low dose of 6.25 mg 0.25% isobaric levobupivacaine (3.75 mg + 2.5 mg) without adjuvants, preserving the possibility of incremental dosing if necessary. Intraoperative monitoring documented exceptional hemodynamic stability throughout the entire procedure (180 min), with mean arterial pressure maintained between 75 and 84 mmHg and heart rate between 63 and 70 bpm, without requiring vasopressors. The sensory block (T10) and motor block (Bromage 3) were adequate and regressed to Bromage 0 by the end of the procedure. The patient remained spontaneously breathing room air with an SpO 2 >98%. The presented case demonstrates that ultra-low dose CSA may represent a valuable option for reducing the perioperative risk in carefully selected high-risk orthogeriatric patients.