<![CDATA[Morbid obesity with uncontrolled hypertension presents significant challenges in anesthetic management due to increased risks of perioperative respiratory complications and hemodynamic instability. This case report aims to describe the use of combined spinal anesthesia and continuous adductor canal block (ACB) in a morbidly obese patient undergoing posterior cruciate ligament reconstruction. A 31-year-old male weighing 130 kg with a height of 173 cm (BMI 43.4 kg/m²) was diagnosed with right posterior cruciate ligament rupture and had a preoperative blood pressure of 168/102 mmHg. Physical and laboratory examinations were otherwise unremarkable. Spinal anesthesia was performed using 15 mg of 0.5% hyperbaric bupivacaine at the L2–L3 interspace. Prior to surgical incision, ultrasound-guided ACB was performed and a continuous catheter was inserted. Postoperatively, a loading dose of 15 mL of 0.25% levobupivacaine was administered via the catheter, followed by continuous infusion of 0.125% levobupivacaine at 5 mL/hour for 48 hours. The three-hour surgery proceeded with stable hemodynamics and no vasopressor requirement. Postoperative pain scores ranged from NRS 1–2 without the need for rescue opioids and without complications. The combination of spinal anesthesia and continuous ACB provided hemodynamic stability and effective analgesia while preserving motor function and minimizing opioid use, suggesting its suitability for patients with similar risk profiles.]]>
