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Background and Aims Managing severe acute pain in patients with pathological fractures secondary to bone metastases poses a significant clinical challenge, negatively impacting their quality of life and the administration of oncological treatments. Systemic analgesia is often insufficient in these cases. Our objective is to present a clinical case that illustrates the effectiveness of using a femoral perineural catheter for controlling severe acute pain.Methods A 76-year-old patient experienced a severely painful pathological right femur fracture with significant functional impairment, which subsequently led to the diagnosis of stage IV lung adenocarcinoma with bone metastases. Due to inadequate pain control with intravenous analgesia and opioids, the Acute Pain Unit (APU) enhanced the multimodal approach by inserting an ultrasound- and neurostimulation-guided femoral nerve catheter.Results The implementation of the femoral perineural infusion demonstrated high efficacy in achieving analgesia, obviating the need for morphine rescue doses. This significantly enhanced the patient’s comfort and psychological well-being, while facilitating in-hospital mobilization and transfers for radiotherapy at the referral center. The catheter remained fully functional and effective for 12 days.Conclusions This case underscores the critical role of continuous regional anesthesia in the management of severe acute pain associated with pathological fractures and bone metastases. It highlights that the efficacy of this approach hinges on three key pillars: precise catheter placement technique, optimal drug selection and dosing, and meticulous monitoring. Multidisciplinary collaboration among the APU, traumatology, and oncology proved essential for the holistic management of this patient.