Supra-inguinal fascia iliaca block under ultrasound guidance for perioperative analgesia during bipolar hip arthroplasty in a patient with severe cardiovascular compromise: A case report

RATIONALE: The relief of selective hip pain may be difficult to attain. Therefore, a deep nerve block such as epidural anesthesia or lumbar plexus nerve block is required. However, deep nerve blocks may not be possible in patients with complications, including severe cardiovascular disease. PATIENTS CONCERNS: The patient in our report had coronary stents inserted previously and required continuous anticoagulant therapy owing to severe heart failure. DIAGNOSIS: Bipolar hip arthroplasty was required in our patient because of a fracture of the neck of femur on the left side. INTERVENTIONS: We decided to perform the surgery using a fascia iliaca block (block of the femoral and the lateral femoral cutaneous nerves) by the suprainguinal approach. The fascia iliaca nerve block was performed under ultrasound guidance, using 20 mL of levobupivacaine. OUTCOMES: The surgery was performed successfully with adequate sensory block around the hip region. LESSONS: Ultrasound-guided fascia iliaca nerve block by the supra-inguinal approach may be an effective anesthetic technique for patients undergoing surgery for fracture of the neck of femur.