BACKGROUND: With recently increase in geriatric population, hip surgery of the aged is increasing likewise as one of the major surgical procedures for orthopedic surgeons. It is the purpose of this paper to study the effects of combined spinal epidural anesthesia on blood pressure, heart rate, pulse oxygen saturation, level of blockade, postoperative pain control and complication in geriatric hip surgery. METHODS: Combined spinal epidural anesthesia was performed with a 27G Whitacre spinal needle through a 18G Weiss epidural needle in 30 patients undergoing elective hip surgery of geriatric patients. 0.5% heavy bupivacaine 2 ml (10 mg) was injected intrathecally. Prolonged anesthesia over 2 hours of operation was accomplished by adding 0.5% bupivacaine through epidural catheter. Onset of sensory anesthesia and motor blockade were measured at frequent intervals. Blood pressure, heart rate and pulse oxygen saturation were checked in preoperative state, 1, 2, 3, 4, 5, 7, 9, 11, 13, 15 minute after injection, and then every 3 minute until the operation was finished. 0.125% bupivacaine 110 ml with morphine 3 mg was provided by Baxter infusor (Baxter Healthcare CO. Deerfield, USA) for postoperative pain control. RESULTS: All 30 patients had adequate anesthesia. Sensory block level was at least above T10 dermatome and motor blockade of lower extremity was Bromage 3 in all patients. Systolic blood pressure and diastolic blood pressure were significantly different (P<0.05) after 3 minutes compared to preoperative state, but any patient had no specific problem. Postoperative pain control was excellent with no significant complication. CONCLUSIONS: Combined spinal epidural anesthesia provided reliable anesthesia for hip surgery of geriatric patients without significant complication.