The aim of the anaesthesia management in patient with severe left ventricular dysfunction (ejection fraction 25%) is to maintain good Intraoperative hemodynamic stability; postoperative analgesia, prevent recurrence of ischemic attacks, which is achieved with combined low dose segmental epidural and ilioinguinal block.

An old woman was admitted with history of pain and swelling in the left groin, vomitings, distension of abdomen since 5 days. History of cardiac illness present since 5 years and is on Digoxin 0.25 m.g.O.D.5days a week,Tab.Enalapril 5 m.g.O.D, ,Tab Atenolol 25 m.g. Bid, Tab clopidogrel 75 m.g.O.D..Patient stopped taking clopidogrel after starting of present complaint. Prothrombin time&.INR.were 15seconds 1.1 respectively. Midazolam 1 m.g.given i.v.as premedicant...C.V.P was used as a guide for administration of intravenous fluids. Patient in sitting posture low dose segmental epidural anaesthesia achieved by injection 5 m.l. of 2%xylocaine into L3-L4 epidural space, catheter passed &,secured. Effect adequate after 10 minutes as evident by decrease in inguinal swelling &blood pressure, facilitating ilioinguinal block, which is achieved by 40 m.l. of 0.25% Ropivacaine.Postoperatively 0.25 %Ropivacaine given epidurally for 48 hours.

There was fall of blood pressure from 154/86 to 84/54 after 18 minutes of combined epidural and ilioinguinal block which was managed by phenylephrine postoperatively patient had absolute pain free period for 48 hours

Combined low dose segmental epidural& ilioinguinal block is safe anaesthesia technique in patients with severe left ventricular dysfunction scheduled for obstructed inguinal hernia.