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Abstract

Elderly patients with multiple comorbidities present a significant challenge during major orthopedic surgeries such as hip arthroplasty. The combined spinal-epidural (CSE) technique offers a balanced approach by providing rapid-onset anesthesia with the advantage of postoperative analgesia.
We report the case of a 68-year-old woman with right intertrochanteric and intracapsular neck of femur fractures scheduled for bipolar hemiarthroplasty. Her comorbidities included hypertension, type 2 diabetes mellitus, coronary artery disease with angioplasty, GOLD stage II COPD (FEV1 62%), and a prior cerebrovascular accident. She was on aspirin and rosuvastatin for secondary prevention. Preoperative findings included mild concentric left ventricular hypertrophy, grade 1 diastolic dysfunction, hemoglobin of 9.2 g/dL, and room air saturation of 90% (improving to 96% on 3 L/min oxygen), with no signs of acute COPD exacerbation. A CSE technique was performed at the L3–L4 level using 2 mL of 0.5% hyperbaric bupivacaine (10 mg) with 25 mcg fentanyl intrathecally, and an epidural catheter was placed for postoperative analgesia. A T10 sensory level was achieved with stable intraoperative vitals. Postoperatively, pain was effectively managed with VAS ≤3/10 using 0.125% bupivacaine 8 mL every 6 hours via the epidural catheter, and no rescue analgesia was needed. The patient was mobilized with assistance on postoperative day one and had an uneventful recovery. This case report highlights that with careful patient selection, the CSE technique can offer a safe and effective alternative to general anesthesia in high-risk geriatric patients.
Abbreviations: CSE: combined spinal-epidural, COPD: Chronic obstructive pulmonary disease, FEV1: Forced expiratory volume in 1 sec, VAS: Visual Analogue Scale
Keywords: Combined spinal-epidural anesthesia; bipolar hemiarthroplasty; elderly; diastolic dysfunction; COPD; stroke; angioplasty; regional anesthesia; high-risk surgery; postoperative analgesia
Citation: Vazhakalayil STJ, Saxena R. Safe use of combined spinal-epidural anesthesia in a high-risk elderly woman undergoing bipolar hemiarthroplasty: a case report. Anaesth. pain intensive care 2025;29(7):817-819. DOI: 10.35975/apic.v29i7.2970
Received: June 07, 2025; Revised: July 16, 2025; Accepted: August 03, 2025