Background: Continuous Spinal Anesthesia provides a good alternative to spinal anesthesia on hemodynamic and postoperative cognitive function for elderly patients undergoing lower limb surgeries. Objectives: To assess hemodynamic and postoperative cognitive function in elderly patients undergoing lower limb surgeries. Subjects and methods: This comparative randomized prospective clinical trial comprised 32 patients over 65 who was scheduled for elective lower limb surgeries estimated. Each patient received a regional anesthetic during the procedures, either through spinal anesthesia (SA) or continuous spinal anesthesia (CSA). Result: The results of the present study showed that there were no significant differences between groups regarding gender, age per years, Body mass index (BMI), American Society of Anesthesiologists (ASA status) or present of comorbidities among studied patients. There was a significantly lower dose of bupivacaine /mg needed in group CSA 11±1.03 versus 12±0 in group SA, p<0.05. Conclusion: the study compared continuous spinal anesthesia (CSA) and single-shot spinal anesthesia (SA) in elderly patients undergoing lower limb surgeries. The results showed that CSA provided better hemodynamic stability, longer-lasting analgesia, and required a lower dose of local anesthetic. However, SA seemed to be associated with improved early postoperative cognitive function. Both techniques were generally well-tolerated, but SA had a higher incidence of hypotension and bradycardia. Overall, the choice between CSA and SA should consider individual patient needs and surgical requirements.