Unilateral spinal anesthesia with fractionated low-dose hyperbaric ropivacaine and fentanyl can enhance hemodynamic control in high-risk lower limb surgeries: a case series

Patients with compromised cardiopulmonary function and multiple comorbidities undergoing spinal anesthesia with conventional bolus dose face significant risks of hemodynamic instability due to sympathetic blockade. In such cases, the necessity of administering vasopressors and large volumes of intravenous fluids often leads to poor postoperative outcomes. However, unilateral spinal anesthesia utilizing fractionated low doses of cardio stable ropivacaine in its hyperbaric form when supplemented with fentanyl has demonstrated remarkable hemodynamic stability. We present five cases of high-risk patients who successfully underwent lower limb surgeries with this approach and with stable perioperative hemodynamics. Keywords: Fractionated Spinal Anesthesia; Low Dose Hyperbaric Ropivacaine; Unilateral Spinal Anesthesia Citation: Rallapalli P, Gollamudi U. Unilateral spinal anesthesia with fractionated low-dose hyperbaric ropivacaine and fentanyl can enhance hemodynamic control in high-risk lower limb surgeries: a case series. Anaesth. pain intensive care 2025;29(1):112-118. DOI: 10.35975/apic.v29i1.2655 Received: September 24, 2024; Reviewed: December 26, 2024; Accepted: December 27, 2024