Combined pericapsular nerve group and lumbosacral erector spinae plane blocks for hip hemiarthroplasty in a high-risk elderly patient

Elderly patients with hip fractures frequently present with severe comorbidities that substantially increase the risks associated with general or neuraxial anesthesia. In particular, severe cardiovascular disease and ongoing anticoagulation may limit anesthetic options. We report the successful use of a multimodal regional anesthesia strategy combining pericapsular nerve group (PENG) block and lumbosacral erector spinae plane (LS-ESP) block to provide surgical anesthesia and analgesia for hip hemiarthroplasty in a highly complex, frail patient. An 87-year-old woman with chronic atrial fibrillation and double mechanical heart valves underwent hip surgery under spontaneous breathing. Effective intraoperative analgesia was achieved with minimal sedation, without respiratory or hemodynamic instability. At the end of surgery, the patient reported complete pain control and remained clinically stable. This case supports the feasibility of combining extended fascial plane blocks as an alternative strategy in selected high-risk patients undergoing major orthopedic surgery.