Regional Nerve Block for Hip Fracture Surgery in an Elderly Patient With Severe Aortic Stenosis: A Case Report

Proximal femoral fractures are most common in elderly patients and are associated with high mortality. Anesthesia strategy in the elderly focuses on minimising its effects on the already impaired cardiopulmonary reserve and cognitive function. We present the anesthesia management of an elderly patient with severe aortic stenosis and demonstrate the benefits of peripheral nerve block (PNB) in trochanteric fracture surgery. A 90-year-old patient was admitted for surgery due to a trochanteric fracture. The anesthesia plan involved administering a PNB. The patient had a medical history of severe aortic stenosis with an aortic valve area of 0.84 cm², hypertension, and chronic kidney disease, which was complicated by melena after admission. After gastroenterological treatment and resolution of symptoms, the patient was scheduled for orthopedic surgery. An ultrasound-guided PNB was performed, which included the fascia iliaca block, femoral nerve block, pericapsular nerve group block, and lumbar plexus block. A total of 35 mL of levobupivacaine at a concentration of 0.25% was applied for the PNB, after which complete anesthesia of the left hip and thigh region was achieved. Six hours after surgery, the pain score measured by a numeric rating scale was 3; analgesia was maintained with paracetamol and a reduced dose of metamizole intravenously. PNB achieves adequate conditions for trochanteric fracture surgery and postoperative analgesia, while preserving hemodynamic stability, which enables early rehabilitation and better recovery after surgery.