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Patient-controlled spinal analgesia for postoperative pain control.

A 70-yr-old woman (111 kg, 157 cm) presented with a comminuted subtrochanteric fracture of the right hip. Her medical history included chronic obstructive pulmonary disease, deep venous thrombosis of both lower extremities, and peripheral vascular disease; medications included lorazepam and furosemide. The scheduled procedure was a right femoral intramedullary nailing with a Russell-Taylor Recon nail and cerclage wiring. With the patient in the left lateral decubitus position, a 17-gauge Tuohy needle was placed at the L2-3 interspace, and a 18-gauge catheter (Perifix, Burron, Bethlehem, Pa.) was inserted 3 cm into the subarachnoid space; no paresthesias were elicited during placement. A millipore filter was connected to the catheter. The patient was turned to the supine position, and a total of 50 mg of 5% lidocaine with 7.5% glucose was injected incrementally over 15 min, resulting in a sensory blockade to T-10. The patient was then repositioned supine on a fracture table by the surgeons. Another 50 mg of lidocaine and 12.5 pg of preservative-free fentanyl was injected incrementally through the intrathecal catheter 1 h later, just before making the surgical incision. During the 4.5-h procedure, an additional 150 mg of lidocaine in divided doses was administered through the catheter to maintain a sensory blockade to T-10. The patient was maintained in the horizontal position throughout all