This study was designed to compare the efficacy of an ephedrine intramuscular injection with crystalloidadministration for the prevention of hypotension during spinal anesthesia in geriatric patients undergoing hip fracture surgery. Twenty-seven ASA II patients scheduled for the .arthroplasty of femoral neck fracture under spinal anesthesia were randomly allocated to receive either 15 ml/kg of Ringer's lactated solution (crystalloid group) or an ephedrine intramuscular injection (ephedrine group). Spinal anesthesia was performed in a lateral decubitus position. According to the patient's height, 10-12 mg of hyperbaric 0,5% tetracaine was injected through a 23-25 gauge spinal needle at the L3-4 or L4-5 interspace. Patients in crystalloid group received Ringer's lactated solution 15 mVkg, over 20 minutes before spinal anesthesia. Patients in the ephedrine group were injectede 30 mg of ephedrine I.M immediately after spinal anesthesia. The incidence of hypotension was 8/12 (66%) in the crystalloid group and 6/15 (40%) in the ephedrine group (p<0.01). There was no significant difference between the groups in the level of anesthesia or heart rate, and hypertension did not occur in either group. The result of this study suggests that the intramuscular injection of ephedrine may be more effective than crystalloid infusion for the prophylaxis of hypotension associated with spinal anesthesia in geriatric patients.