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1,2,4 Assistant Professor, Dept of Anaesthesiology, Govt Medical College, Thiruvananthapuram, Kerala 3 Professor, Dept of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala *Corresponding Author Divya Madhu Assistant Professor, Dept of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala. Telephone Number: 9895436358, Email: drdivyabineesh@gmail.com Abstract Spinal anaesthesia with hyperbaric Bupivacaine is the most popular technique for lower limb surgeries in geriatric patients. hypotension and bradycardia are very common in this age group .In this study we have tried low dose intrathecal Bupivacaine with Fentanyl combined with epidural block in an attempt to reduce the side effects.120 ASA 3 patients between 65 and 80 years of age were randomly allocated into two equal groups. The control group (B) received spinal anaesthesia alone with 2ml 0.5% hyperbaric Bupivacaine with 25 microgram Fentanyl. The study group (A) received Combined spinal epidural anaesthesia with a low dose of 1ml 0.5% hyperbaric Bupivacaine and 25 microgram Fentanyl intrathecally. The sensory level of T10 if not attained was achieved with small incremental doses of 0.5% Bupivacaine administered through the epidural catheter.The incidence of hypotension in the study group was 25% vs 98.33% in the control group. (p < 0.05). Bradycardia occurred in 6.66% in the study group vs 56.66% in the control group (p< 0.05). The maximum fall in BP from baseline was 20.9±6.4 mmHg in the study group compared to 41.8 ±5.3 mmHg in the control group which was statistically significant. The total dose requirement of vasopressor to treat hypotension in the control group was significantly higher. Only 25% of patients in the study group required a dose more than 6mg of Ephedrine compared to 91.7% in the control group (p<0.01). Administration of Combined spinal epidural anaesthesia with low dose intrathecal Bupivacaine and Fentanylcauses lesser incidence of hypotension and bradycardia with reduced vasopressor requirements. Thus, a low dose intrathecal Bupivacaine with Fentanyl combined with epidural anaesthesia gives a stable haemodynamic profile in high risk geriatric patients for proximal femoral surgeries.

Combined Spinal Epidural Block Using Low Dose Intrathecal Bupivacaine with Fentanyl in High Risk Geriatric Patients for Proximal Femoral Surgeries