Use of low-dose local anesthetics in the spinal component of the CSE minimizes the risk of systemic toxicity and adverse effects on cardiac function, while still achieving satisfactory anesthesia levels. A 73 year old male diagnosed with carcinoma bladder (2cm growth on posterior border) was posted for TURBT under Low dose of combined spinal epidural (CSE). Surgery went uneventful with less blood loss and all the hemodynamic parameters were stable with no intraoperative complaint of pain. CSE is considered as a safer option for post PTCA patients as it maintained hemodynamic stability, provide pain relief with less incidence of perioperative morbidity.