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Application for ESRA Abstract Prizes:Background and Aims Managing quadriplegic patients for non-spinal surgery remains challenging due to the complex pathophysiological changes associated with spinal cord injury (SCI). Autonomic dysreflexia (ADR), a life-threatening complication triggered by surgical stimuli below the level of injury, most commonly of urologic origin, requires particular attention. This case report presents the anesthetic management of a quadriplegic patient undergoing an urologic procedure, emphasizing strategies to prevent ADR.Methods A 79-year-old, ASA III, male patient with a history of C5 SCI and cervical spine surgery six months ago, was scheduled for suprapubic catheter placement for a neuropathic bladder. Preoperative evaluation revealed normal cardiac function and a restrictive ventilatory pattern with small airway disease. His medication included fondaparinux, famotidine, filicine, d-mannose, alprazolam and ciprofloxacin. Laboratory tests were within normal limits. No episodes of ADR were reported. After obtaining informed consent, the patient was placed in the lateral decubitus position under standard monitoring, and 2.6 ml of 0.5% levobupivacaine was administered intrathecally. A nitroglycerin infusion (1 μg/ml) was prepared for immediate use in case of ADR.Results The procedure lasted 35 minutes and the patient remained hemodynamically stable. No signs of ADR were observed during bladder distension. The exact level of the subarachnoid block could not be determined intraoperatively, highlighting a common limitation in the intraoperative assessment of sensory block levels in SCI patients.Conclusions This case supports the safety and effectiveness of regional anesthesia for preventing ADR in SCI patients undergoing urologic procedures. Given the variability in presentation and risks, individualized anesthetic planning remains essential for optimal outcomes.