Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 1 2025 01 01 1012 1012 EN Maryam Vosoughian Anesthesiology Research Center, Department of Anesthesiology & Critical Care, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Shide Dabir Anesthesiology Research Center, Department of Anesthesiology & Critical Care, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Faramarz Mosaffa Anesthesiology Research Center, Department of Anesthesiology & Critical Care, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2024 05 23 2024 06 09 Spinal anesthesia is generally prohibited in patients with severe valvular heart disease (e.g. severe aortic stenosis), cardiomyopathies and heart failure concerning the hemodynamic effects of sympathetic system blockade in patients with limited cardiac output. Intrathecal single injection of low doses of local anesthetic  in combination with low dose short acting opioids can be administered safely in lower abdominal and lower limb surgeries lasting 60 to 90 minutes . In longer surgeries, epidural catheters can be inserted through the epidural needle into the intraspinal space and intermittently administered low doses of local anesthetic plus low doses of fentanyl or sufentanil as needed. https://aacc.tums.ac.ir/index.php/aacc/article/view/1012