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Background and Aims In this review, our clinical experience with neuraxial blockade by using a height adjusted dose of 0.5% isobaric bupivacaine on 1000 ASA physical status I–IV patients undergoing lower limb orthopedic surgery was evaluated. The aim was to summarize anesthetic and hemodynamic effect.Methods In recent years height adjusted doses of 0.5% isobaric bupivacaine were used for intrathecal administration prior to lower limb orthopedic procedures shorter than 120 minutes. All patients were older than 18 and with ASA physical status I–IV. In table 1 are listed the used doses. In each height group, the lowest dose of the corresponding bupivacaine dosing interval was given to patients over 65 years, patients with ASA physical status III or IV and for knee surgery, while for hip and femur surgery the highest dose of the corresponding bupivacaine dosing interval was administered.Abstract P022 Table 1Height adjusted doses of 0.5% isobaric bupivacaine for lower limb orthopedic surgeries Height (cm) 0.5% isobaric bupivacaine (ml) 0.5% isobaric bupivacaine (mg) 150–1602.0–2.410–12160–1702.2–2.611–13170–1802.6–3.013–15180–1902.8–3.214–16>190>3.2>16Results In most cases the height adjusted dose of isobaric bupivacaine provided an adequate level of anesthesia to safely perform the lower limb orthopedic surgery. Moreover, patients were hemodynamically stable, the incidence of hypotension and bradycardia were very low (<2%). In 1–2% of cases the protocol was changed to general anesthesia, because the level of anesthesia was insufficient or became inadequate during the procedure.Conclusions The intrathecally administered height adjusted dose of 0.5% isobaric bupivacaine is associated with adequate level of anesthesia to safely perform the lower limb orthopedic surgery. It provides hemodynamic stability, which is especially significant for elderly and polymorbid patients. The incidence of adverse effects are relatively low and rarely require pharmacological intervention.