Postdural Puncture Headache Research Articles

Efficacy of Nusinersen Treatment in Type 1, 2, and 3 Spinal Muscular Atrophy: Real-World Data from a Single-Center Study

Background: Spinal muscular atrophy (SMA) is an inherited neuromuscular disease characterized by progressive muscle weakness and atrophy due to the absence of the survival motor neuron 1 (SMN1) gene. SMA is classified into types 0 through 4 based on the age of symptom onset and the severity of motor function decline. Recent advances in SMA treatment, including nusinersen, onasemnogene abeparvovec, and risdiplam, have significantly improved the prognosis of SMA patients. This study evaluated the safety and efficacy of nusinersen in pediatric patients with SMA types 1, 2, and 3 in a real-world clinical setting. Methods: This prospective observational single-center study assessed the treatment effects of nusinersen in 23 pediatric patients with genetically confirmed SMA over a 22-month observation period. All the participants received intrathecal loading doses of 12 mg of nusinersen on days 1, 14, 28, and 63, followed by maintenance doses every four months. Functional assessments were conducted using the CHOP-INTEND scale. Data were collected during routine patient visits, including clinical laboratory tests and vital sign parameters, and adverse events were recorded. The inclusion criteria were defined by the national reimbursement program for nusinersen treatment in Poland. Results: Initially, 37 patients ranging from 1 month old to 18 years old were included, but 23 were ultimately observed due to changes in treatment regimens or assessment scales. The patients showed significantly improved CHOP-INTEND scores over the 22-month period. At 6 months, the average increase was 4.2 points, continuing to 17.8 points at 22 months. By the end of the study, 100% of patients showed either stabilization or improvement, with significant clinical improvements observed in several patients. Nusinersen was generally well-tolerated, with post-lumbar puncture headache and lower back pain being the most common adverse events. Conclusions: Nusinersen treatment significantly enhances motor function in pediatric patients with SMA types 1, 2, and 3. This study demonstrates the importance of early and sustained treatment, with most patients showing the continuous improvement or stabilization of motor function. These findings support the use of nusinersen as an effective therapy for SMA; however, further research is needed to understand the long-term outcomes and optimize treatment strategies.

Conquering Post-Dural Puncture Headache: A Systematic Review of Effective Treatments

Post-dural puncture headache (PDPH) is a common complication following spinal procedures, particularly lumbar punctures and epidural anesthesia. This systematic review aims to evaluate and compare the effectiveness of various management strategies for PDPH. A comprehensive search was conducted across major databases for relevant articles published up to January 2024. The inclusion criteria comprised studies assessing interventions for post-dural puncture headache (PDPH) management in adult populations. Data extraction and quality evaluation were conducted independently by two reviewers. Analysis involved 34 studies meeting the inclusion criteria. The results indicate that conservative approaches, including bed rest, hydration, caffeine, and analgesics, continue to serve as the fundamental components of PDPH management. Additionally, epidural blood patch (EBP) emerged as the most effective intervention for refractory cases. However, further research is needed to optimize treatment protocols and explore emerging therapies.

The Relationship Between Age and The Incidence of Post Dural Puncture Headache in Post Sectio Caesarea Patients with Spinal Anesthesia

Background: Caesarean Section (CS) is a surgical procedure involving incisions in the abdominal wall and uterus. Spinal anesthesia is the preferred method due to the lower maternal morbidity and mortality risks compared to general anesthesia. However, the most common complication associated with spinal anesthesia is Post Dural Puncture Headache (PDPH), caused by a dural puncture. Age is a significant factor influencing PDPH occurrence. Patients aged 20-40 are at a higher risk, while those over 50 years have a reduced risk due to the decrease in cranial elasticity and pain sensitivity with age. Purpose: This study aims to assess the correlation between age and the incidence of PDPH following spinal anesthesia in CS patients. Methods: This study employed a cross-sectional analytic correlation design. The sample included all CS patients who received spinal anesthesia and met the study criteria, totaling 35 respondents. Data were analyzed using univariate and bivariate analysis, with the correlation significance tested at 0.05 (2-tailed). Findings: The study revealed that 14.3% of respondents experienced PDPH, while 85.7% did not. A significant correlation was found between age and PDPH incidence, with a p-value of 0.05. The highest incidence of PDPH was observed in the 20-40 age group, decreasing notably in individuals aged 50 and above. Conclusion: This study highlights that PDPH risk is highest in patients aged 20-40 and significantly decreases in patients older than 50. Age-related changes in cranial structure and pain sensitivity likely contribute to this decreased risk.

Efficiency of dexamethasone in reducing the incidence of headaches after spinal anesthesia during caesarean section

Background. A caesarean section is the delivery of a fetus through an abdominal incision (laparotomy) and a uterine incision (hysterectomy). The anesthesia method most often used for caesarean birth is spinal anesthesia, the prevailing complication of spinal anesthesia (SA) is post-dural puncture headache. Aims of the study. To investigate the effects of dexamethasone in reducing the incidence of headache and pain in spinal anesthesia in caesarean section. Subjects and methods. Clinical trial was conducted at Basra Maternity and Children Hospital from January 1, 2022 to July 1, 2023. The studied population was divided into two groups: Group I included 98 patients who received intravenous dexamethasone 0.2 mg/kg (maximum 16 mg) just after the spinal anesthesia, and Group II, the control group, which included 100 patients who received IV normal saline prior to spinal anesthesia. The average severity of headache was evaluated using the visual analogue scale (VAS) after recovery within the first hour, 24 hours, 48 hours, and 1 week. Results. Dexamethasone usage significantly reduced postoperative pain (no pain: 89.7% vs. 68.0%), with a p-value equal to 0.001. No notable differences were found in sociodemographic characteristics, PDPH incidence (recovery time: 8.1% vs. 9.0%, 24 hours: 10.2% vs. 9.0%, 48 hours: 4.08% vs. 5.0%, one week: 0.0% vs. 0.0%). Conclusion. Dexamethasone given intravenously had no discernible effect on headaches following a spinal puncture. It dramatically lowers pain after surgery, but it has no discernible impact on bradycardia, nausea or vomiting, shivering, or postoperative hypotension.

Comparison of nerve block and spinal anesthesia in second toe pulp free flap surgery for fingertip reconstruction.

Toe pulp flap surgery is a viable option for soft tissue defects of the fingertips, effectively addressing patient needs and fingertip characteristics. The preferred anesthesia for lower-extremity surgery includes spinal and regional anesthesia. However, the choice between these methods depends on patient safety and surgical efficacy. In this retrospective study, we aimed to ascertain the optimal anesthetic technique by examining the efficacy, safety, pain control, and potential side effects of spinal and peripheral nerve block anesthetics. We included 40 patients aged 18-60 years who underwent partial second toe pulp free flap surgery for fingertip reconstruction. Twenty patients received spinal anesthesia (SA), while the remaining 20 received peripheral nerve block anesthesia. We conducted a comparative analysis of postoperative pain scores, adverse effects, analgesic usage, and patient satisfaction scores associated with each anesthesia method. Independent t-test, Mann-Whitney U test, and chi-squared test were performed. The SA group exhibited hypotension, bradycardia, urinary retention, and postdural puncture headache rates of 10%, 10%, 5%, and 5%, respectively. A significant difference in the timing of first analgesic use was observed (spinal, 3.7 ± 0.8 vs. peripheral nerve block, 13.2 ± 6.6; P = 0.006). Visual analog scale (VAS) scores of the patients at the 2nd, 4th, and 6th h were significantly lower in the peripheral nerve block group (P < 0.001, P < 0.001, P < 0.001, respectively). VAS scores at 12 and 24 h were similar between the groups (P = 0.07, P = 0.135, respectively). Peripheral nerve block anesthesia is superior to SA for partial second toe pulp free flap surgery, offering lower complication rates, reduced postoperative pain, and improved patient comfort.

The Role of Regional Anesthesia in Reducing Postoperative Pain in Pediatric Patients

Introduction: Ensuring adequate analgesia is crucial for minimizing morbidity and healthcare costs, ultimately enhancing the success of ambulatory surgery outcomes. The purpose of this study was to evaluate the effectiveness of regional anesthesia in reducing postoperative pain in pediatric patients. Aim of the study: The aim of this study was to evaluate the effectiveness of regional anesthesia in reducing postoperative pain in pediatric patients. Methods: This prospective observational study included 60 pediatric patients who underwent various surgical procedures with regional anesthesia at the Department of Anaesthesia, Analgesia, and Intensive Care Medicine, BSMMU, Dhaka, Bangladesh, from January 1, 2022, to December 31, 2023. Patients aged &lt; 15 years were included, with baseline pain scores recorded preoperatively and postoperative pain levels assessed at 1, 3, 6, 12, and 24 hours. Data on regional anesthesia techniques and pain scores were analyzed using SPSS version 22.0. Result: The study revealed that the largest group of pediatric patients were aged 7–14 years, with regional anesthesia techniques like upper and lower limb blocks being the most common. Postoperatively, 33.33% of Neonates and Infants reported a pain score of 0 within the first 3 hours, while nausea and postdural puncture headache (PDPH) were observed in 25.00% and 13.33% of patients, respectively. Most patients had a hospital stay of 4–6 days, though 21.67% required more than 10 days. Conclusion: Regional anesthesia effectively reduced postoperative pain in pediatric patients, demonstrating significant pain management benefits, minimal complications, and a positive impact on recovery and hospital stay duration.

Prevention and treatment approaches of post-dural puncture headache in obstetric patients: A comprehensive review

Neuraxial anesthesia and analgesia are administered to many patients. The incidence of dural puncture is about 1%, with a higher occurrence in laboring women. Post dural puncture headache (PDPH) develops in 60%-80% of patients after dural puncture which is usually positional and sometimes is accompanied by neck stiffness, photophobia, nausea, or hearing symptoms. It can also drive-up healthcare costs by increasing the length of hospital stay for chronic headache and back pain. PDPH has the potential to cause significant morbidity in the obstetric patients which prolongs the hospital stay. Epidural blood patch (EBP) is considered the gold standard for the management of PDPH. Proper scheduling of analgesics and supporting the patient psychologically as she cares for her newborn is needed. If the intensity of headache is severe, additional agents may be considered. In this review, the different methods and therapeutic approaches for prevention and treatment of PDPH are comprehensively discussed.

Avoiding Invasive Measures: Sphenopalatine Ganglion Block as a Substitute for Epidural Blood Patch in Post-dural Puncture Headache: A Case Report

Introduction: Post-dural puncture headache (PDPH) is a well-known consequence of neuraxial anesthesia that can impede patient recovery and delay early discharge. Traditional remedies include hydration and the administration of simple analgesics for symptom relief. When symptoms persist despite conservative interventions, an epidural blood patch (EBP) is typically recommended. However, this invasive procedure carries risks and complications. Our case report aims to explore a potential alternative treatment for PDPH. Case Presentation: We present the case of a 22-year-old female who experienced PDPH following spinal anesthesia. Despite initial attempts at conservative management, her symptoms persisted. She then opted for a trans-nasal sphenopalatine ganglion (SPG) block, which resulted in remarkable pain relief and eliminated the need for an EBP. Conclusions: The SPG block emerges as a minimally invasive option for treating PDPH. Multiple studies have demonstrated that patients undergoing SPG block therapy did not require EBP.

Spontaneous intracranial hypotension mimicking iatrogenic spinal cerebrospinal fluid leaks.

To raise awareness that patients with persistent post-dural puncture headache should be considered for evaluation of spontaneous cerebrospinal fluid (CSF) leak. Spontaneous intracranial hypotension (SIH) due to a spinal CSF leak may occur following more-or-less trivial traumatic events. We report our experience with spontaneous spinal CSF leaks that occur following percutaneous or open spine procedures, a potential source of diagnostic confusion. In a retrospective cohort study, using a prospectively maintained database of patients with SIH, we identified all new patients evaluated between January 1, 2022, and June 30, 2023, who were referred for evaluation of an iatrogenic spinal CSF leak but were found to have a spontaneous spinal CSF leak. Nine (4%) of the 248 patients with SIH were originally referred for evaluation of an iatrogenic spinal CSF leak. The spinal procedures included epidural steroid injections, laminectomies, epidural anesthesia, and lumbar puncture. Brain magnetic resonance imaging (MRI) showed changes in intracranial hypotension in seven of the nine patients (78%). The spontaneous CSF leak was found to be at least five levels removed from the spinal procedure in all patients. A spontaneous spinal CSF leak should be suspected in patients with recalcitrant orthostatic headaches following a spinal procedure, even if symptoms of the leak occur within hours of the spinal procedure and especially if brain MRI is abnormal.

The Prophylactic Effect of Acetaminophen and Caffeine on Post Dural Puncture Headache after Spinal Anesthesia for Cesarean Section: A Randomized Double-Blind Clinical Trial.

Post-dural puncture headache (PDPH) is the most common complication following spinal anesthesia among parturients undergoing cesarean section surgery. The purpose of this study was to evaluate the effectiveness of acetaminophen and caffeine in preventing PDPH. This double-blind, randomized clinical trial was conducted on 96 obstetric women, who were candidates for elective cesarean section. Following the randomization of participants into two groups, participants in the intervention group received tablets of acetaminophen (500 mg)+caffeine (65 mg), and participants in the control group received placebo tablets orally 2 hours before spinal anesthesia induction and then every 6 hours after surgery up to 24 hours. All parturients were evaluated for frequency and intensity of PDPH every 6 hours until 24 hours after surgery and then 48 and 72 hours after surgery. Overall satisfaction during the first 72 hours of postpartum was evaluated. The data were analyzed using SPSS software. P<0.05 was considered statistically significant. Participants in the intervention group were 70% less likely to experience PDPH after spinal anesthesia (OR=0.31 P=0.01, 95% CI [0.12-0.77]). They also experienced significantly milder headaches 18 hours, 48 hours, and 72 hours later. Participants in the intervention group reported higher levels of satisfaction at the end of the study (P=0.01). No side effects related to the intervention were reported. Prophylactic administration of acetaminophen+caffeine decreases 70% the risk of PDPH and significantly attenuates pain intensity in obstetric patients who underwent spinal anesthesia for cesarean section.

Aminophylline versus Ketamine in prophylaxis against post-dural puncture headache in pregnant females undergoing cesarean section: A comparative study

Aminophylline versus Ketamine in prophylaxis against post-dural puncture headache in pregnant females undergoing cesarean section: A comparative study

Role of Cosyntropin in the Management of Postpartum Postdural Puncture Headache: A Two-center Retrospective Cohort Study

Role of Cosyntropin in the Management of Postpartum Postdural Puncture Headache: A Two-center Retrospective Cohort Study

Role of Cosyntropin in the Prevention of Postdural Puncture Headache: A Propensity-matched Retrospective Analysis

Role of Cosyntropin in the Prevention of Postdural Puncture Headache: A Propensity-matched Retrospective Analysis

Post-dural puncture headache treated with grater occipital nerve block

Introdution: post-dural puncture headache (PDPH) is an importante and relatively frequent complication after dural puncture. It is a intense pain that worsens when sitting or standing and improves when lying down. Epidural blood tamponade is the most effective treatment, but it is invasive. Objective is to demonstrate the results of greater occipital nerve (GON) block in the treatment of PDPH. Method: 3 patients after cesarean section with PDPH were evaluated. They agreed to GON blockade after failure of hydration, bed rest and analgesics. Blockade was performed bilaterally with 2 ml of lidocaine (20 mg/ml) and 2 ml of dexametasone (2 mg/ml). Results: analogic visual scale (AVS) before the procedure was 8 for the first patient, 8 for the second and 9 for the third respectively, with the patients sitting (average 8.3). After 2 hours of GON blockade, the AVS was 1, 2 and 2 respectively (average 1.6). After 24 hours, the AVS was 0, 1 and 1 (average 0.6). No side effects were reported. Conclusion: in the cases in question, GON blockade showed good efficacy in the treatment of PDPH. The procedure is simple and quite safe. Although epidural blood patching is the definitive treatment for PDPH, GON blockade is an option to be considered for the treatment of these patients.

CT-Guided Epidural Contrast Injection for the Identification of Dural Defects.

Post-dural puncture headache (PDPH) is an increasingly recognized cause of chronic headache. Outside of clinical history and myelography that requires an additional dural puncture, there is no reliable diagnostic test to evaluate for persistent dural defects. We describe the injection of iodinated contrast into the dorsal epidural space under CT guidance in five patients as a potential tool to visualize persistent dural defects.ABBREVIATIONS: PDPH = post-dural puncture headache; SIH = spontaneous intracranial hypotension; DSM = digital subtraction myelography; CTM = CT myelography.

Post-dural Puncture Headache: A Comparative Study Using 25 G Quincke's Needle in Midline and Paramedian Approaches in Patients Undergoing Elective Cesarean Section.

Background and objectives Spinal anesthesia (SA) has become a preferred anesthetic technique for elective cesarean sections due to its rapid onset, profound sensory and motor blockade, and minimal impact on the newborn. It lowers the risk of development of thrombus in the veins and pulmonary vessels and permits early ambulation. The most popular technique used to reach the subarachnoid space is the midline technique, though it can be challenging to use in some cases, including those involving elderly patients with degenerative abnormalities in the vertebral column, patients who are unable to flex the vertebral column, noncooperative patients, and hyperestheticpatients. The paramedian technique resolves the challenges posed by the midline technique. It is also relatively easy to carry out. Based on the midline technique's inadequacies, we hypothesized that the paramedian method of SA would be less complicated than the midline approach, with a relatively low occurrence of post-dural puncture headaches (PDPH). Methodology Using the midline and paramedian approaches during cesarean surgeries, we performed an observational descriptive longitudinal study to assess the occurrence and magnitude of PDPH. During an elective cesarean delivery, the seated patient received 2.0-2.5 ml of hyperbaric bupivacaine using the midline or paramedian approaches and a 25 G Quincke's needle at the L3-L4 level. Eighty-four pregnant females with American Society of Anesthesiologists (ASA) physical status II, aged 18 to 35 (n = 42 in each group), were included in this research. The occurrence and severity of PDPH were compared among thegroups during a period of five days. Result In comparison to the paramedian group (7.1%), the midline group had a higher incidence of PDPH (14.3%). There was a significant correlation between the technique and the occurrence of PDPH (p = 0.041). The visual analogue scale (VAS) was employed to quantify pain five days after surgery. Pain levels in Group B (paramedian) were consistently less than those in Group A (midline). On day 1, Group B had a mean score of 0.49 ± 1.16 (p = 0.030) compared to Group A's mean VAS score of 1.27 ± 1.95. Day 5 (p = 0.032): Because this tendency persisted through day 5, the p-values for days 2, 3, 4, and 5 remained significant. These findings suggest that the midline technique is linked to a higher occurrence and magnitude of PDPHthan the paramedian approach. Conclusion Employing a paramedian technique has been associated with a noteworthy decline in the frequency of PDPH and a decrease in the need for additional analgesics, which could lead to a less severe case of PDPH. The paramedian approachneeded fewer attempts and needle passes, which leads to a lower incidence of headache, backache, and injection site pain and better patient satisfaction.

Prophylactic cosyntropin after unintentional dural puncture and incidence of post-dural puncture headache and epidural blood patch use: A retrospective cohort study (2019–2022)

BackgroundCosyntropin has been suggested to decrease the incidence of post-dural puncture headache (PDPH) by increasing the production of cerebrospinal fluid. This study examined the association of prophylactic cosyntropin administration with the incidence of PDPH and its management with an epidural blood patch after an unintentional dural puncture (UDP). MethodsWe conducted a retrospective cohort study of cases with UDP during placement of neuraxial labor analgesia. Per institutional practice and at the discretion of the anesthesiologist, intravenous cosyntropin 1 mg may be administered for PDPH prophylaxis. PDPH, time from UDP to cosyntropin administration, time to development of PDPH, and management with epidural blood patch(es) were recorded. ResultsCosyntropin was administered in 164 of 234 (70%) cases with UDP. PDPH occurred 98/164 (60%) with cosyntropin and 45/70 (64%) without cosyntropin (p = 0.66). The PDPH adjusted incidence was 53% with cosyntropin and 62% without cosyntropin, difference 9% (95% CI −6% to 24%, p = 0.25). The adjusted epidural blood patch rate was 66% with cosyntropin and 78% without cosyntropin, difference of 12% (95% CI −5% to 28%, p = 0.17). ConclusionsProphylactic cosyntropin following UDP was not associated with a significant decrease in PDPH rate or use of epidural blood patch for management of PDPH. There was no significant difference in the rate of adverse hyperglycemic or hypertensive events amongst those who did or did not receive cosyntropin.

Diagnostic and therapeutic insights in individuals with persistent post-dural puncture headache: A cross-sectional study.

Post-dural puncture headache (PDPH) is a frequent complication following lumbar puncture, epidural analgesia, or neuraxial anesthesia. The International Classification of Headache Disorders, third edition categorizes PDPH as a self-limiting condition; however, emerging evidence, including our findings, suggests that PDPH can have a prolonged course, challenging this traditional view. To elucidate the diagnostic characteristics and treatment outcomes of persistent PDPH (pPDPH), offering insights into its demographic profiles and diagnostic features. We executed an anonymous, web-based survey targeting individuals aged ≥18 years diagnosed with or suspected of having pPDPH. Recruitment occurred through self-help groups on Facebook. The survey comprised questions regarding diagnostic procedures, treatment regimens, outcomes, and healthcare consultation. The survey achieved a response rate of 179/347 (51.6%) individuals completing the questionnaire. Cerebrospinal fluid (CSF) leaks were confirmed in nine of 179 (5.0%) cases. Signs of intracranial hypotension without a CSF leak were observed in 70/179 (39.1%) individuals. All participants underwent magnetic resonance imaging scans of the brain and spine, with computed tomography myelography performed in 113/179 (63.1%) cases. Medications, including analgesics, theophylline, and gabapentin, provided minimal short-term relief. Epidural blood patch treatments resulted in slight-to-moderate short-term improvement in 136/179 (76.0%), significant improvement in 22/179 (12.3%), and complete effectiveness in eight of 179 (4.5%) individuals. For long-term outcomes, slight-to-moderate improvement was reported by 118/179 (66.0%) individuals. Surgical interventions were carried out in 42/179 (23.5%) patients, revealing pseudomeningoceles intraoperatively in 20/42 (47.6%) individuals. After surgery, 21/42 (50.0%) of the participants experienced slight-to-moderate improvement, 12/42 (28.6%) showed more pronounced improvement, and five of the 42 (11.9%) achieved complete effectiveness. This study underscores the complexities of managing pPDPH. The delay in diagnosis can impact the effectiveness of treatments, including epidural blood patch and surgical interventions, resulting in ongoing symptoms. This underscores the importance of tailored and adaptable treatment strategies. The findings advocate for additional research to deepen the understanding of pPDPH and improve long-term patient outcomes.

Ultrasound‐assisted and landmark‐based nusinersen delivery in spinal muscular atrophy adults: A retrospective analysis

AbstractIntroduction/PurposeNusinersen, the first treatment approved for all spinal muscular atrophy (SMA) types, is administered intrathecally through lumbar puncture. We used ultrasound assistance or a landmark‐based technique to access the lumbar intrathecal space in adult SMA patients. This study aimed to evaluate the technical success and adverse events (AEs) in such patients using either technique over a long observation period.MethodsFifty‐one adult patients received 507 consecutive interlaminar nusinersen administrations. Patients presented with both ‘uncomplicated spines’ or ‘complicated spines’; two patients had previous back surgery. Technical success and AEs were recorded using either technique. A generalised linear mixed model was applied to evaluate predictors of technical success and complications.ResultsAn overall success rate of 99.6%, with only two procedures failing to reach the intrathecal space, and an overall optimal procedure rate of 90.3% have been reported. A total of 455 procedures (89.7%) were uneventfully performed. One (0.2%) case of severe AE (puncture of a bulky abdominal annexal cyst) was recorded. Twenty‐seven episodes (5.3%) of post‐dural puncture headache (PDPH) and 24 episodes (4.7%) of radicular or back pain, both successfully treated with medical therapy, have also been reported. Technical success was significantly associated with ‘complicated spines’ (P = 0.022) and the use of ultrasound assistance (P = 0.01), and the use of ultrasound was the only independent predictor of uncomplicated procedures (P = 0.007).DiscussionIn adult patients with SMA both landmark‐based and ultrasound‐assisted techniques are safe and effective even in the long term. The use of assistance is associated with technical success and can predict uncomplicated procedures.ConclusionOur results support the use of ultrasonography in order to improve the success and reduce the burden of nusinersen intrathecal administration.

Effects of Continuous versus Single Dose Spinal Anesthesia in Octogenarians Undergoing Hip Surgery: Randomized Control Trial

Abstract Background Continuous spinal anesthesia (CSA) is an anesthetic technique that offers several clinical advantages for anesthesia and analgesia in elderly patients. The level of sensory blockade can be titrated to the desired dermatomal level with great precision with intrathecal (IT) catheters, allowing better control of the hemodynamic consequences of sympathetic blockade associated with spinal anesthesia compared to epidural or single shot spinal techniques. Octogenarians are expected to suffer more from hemodynamic instability with spinal anesthesia. Objective The primary outcome is to compare the incidence of hypotension (defined as decrease in mean arterial blood pressure &amp;gt; 20% from the base line) in continuous spinal anesthesia CSA versus single dose spinal anesthesia in octogenarians undergoing hip surgery. The secondary outcome is to determine the total use of vasopressor (Ephedrine) and the incidence of spinal complications as nausea, vomiting and post Dural puncture headache. Methods This is a randomized controlled clinical trial done at Ain-shams University Hospitals, Cairo, Egypt within a period of 6 months from approval of medical ethics committee. Twenty patients in CSA group received increments of (0.5 ml) of plain bupivacaine 0.5% until T10 level blockade is achieved. Twenty patients in SDA group received single shot of (2.5ml) of bupivacaine 0.5%. Results The main finding of this study is that while MAP was significantly lower between 5-35 minutes (&amp;lt;0.001), it was significantly higher between 40-75 minutes in SDA group than CSA group (0.05).Total bupivacaine dose was significantly higher in SDA (12.5±0.8) group than CSA group (7.6±1.3) (p &amp;lt; 0.001). The total ephedrine dose needed was significantly higher in the SDA group (19.5 ±11.3) than in CSA group (4.5±1.7) (p.0.006). Conclusion The main finding of this study is that for octogenarians undergoing hip surgery, while MAP was significantly lower between 5-35 minutes, it was significantly higher between 40-75 minutes in single dose spinal anesthesia group than continuous spinal anesthesia group. Episodes of bradycardia were similar in both groups. The bupivacaine dose as well as total ephedrine dose was significantly higher in SDA group than CSA group. Groups were similar in the incidence of postoperative complications related to the neuraxial blockade. The impact of these changes on the overall cardiovascular status and outcome in octogenarians undergoing hip surgery could not be determined from our study design.