ABSTRACT : We present case of 65yr old male patient with IHD posted for emergency fourniers gangrene debridement. This case study describes advantage of low dose spinal anesthesia with post-op epidural analgesia over regular dose sole SA in patients with IHD with wall motion abnormalities and LVEF <42%.

METHODS : Under adequate local anaesthesia epidural catheter was introduced in L2-3 space and fixed. In L3-4 space spinal block done with 7.5mg 0.5%(H)Bupivacaine. Procedure lasted 45 minutes. Post-operatively analgesia was provided with 1.25% Bupivacaine +tramadol 50mg in epidural space at regular intervals for next 24hrs.

RESULTS : Post-spinal fall in BP was minimal with MAP being 60-65mm hg intra-op vs 80mm hg during pre-operative check-up without any need for vasopressor. SPO2, pulse rate and ecg were stable throughout the procedure. Post-operative period was uneventful with controlled BP and no stress induced ecg changes.

CONCLUSIONS : Low dose spinal block with epidural analgesia is safe and effective method in patient with h/o IHD with low LVEF.