Peripheral nerve blocks as an alternative for total hip endoprosthesis surgery in elderly patients with femoral fracture

Proximal femoral fractures represent a significant anesthetic challenge in the geriatric population. Advanced age, frailty, and multiple comorbidities are associated with increased perioperative risk, particularly in the context of general anesthesia, while neuraxial techniques may be limited by the frequent use of anticoagulant therapy. Ultrasound-guided peripheral nerve blocks (PNBs) combined with light sedation may offer a potential alternative approach in selected high-risk patients. We report two elderly female patients (aged 91 and 99 years) with proximal femoral fractures who underwent total hip endoprosthesis surgery. Anesthetic management consisted of a lumbar erector spinae plane (L-ESP) block combined with a fascia iliaca compartment block (FICB). Sedation was administered via target-controlled infusion (TCI) of propofol, and depth of sedation was continuously monitored using the Conox system (Fresenius Kabi, Bad Homburg, Germany). Both procedures were completed without conversion to general or neuraxial anesthesia. Intraoperative hemodynamic parameters remained within acceptable ranges, and postoperative analgesia was adequate. No episodes of postoperative delirium or major perioperative complications were observed. These cases suggest that the combined use of L-ESP and FICBs, supplemented with light TCI-guided sedation, may represent a feasible anesthetic alternative in carefully selected elderly patients undergoing total hip endoprosthesis surgery for femoral fracture. Further investigation in larger cohorts is warranted to better define its role in this setting.