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Background and Aims Concomitant aortic stenosis (AS) in fragility fracture patients, makes anesthesia management challenging, and amplifies surgical risks by causing left ventricular dysfunction and reducing coronary artery perfusion, leading to 30-day mortality rates that are 2–3x greater compared to non-AS patients. This case report details the successful use of a combined psoas compartment and parasacral sciatic nerve block in an elderly Filipino patient with severe AS undergoing proximal femoral nailing.Methods We report a case of a 75-year-old Filipino woman with severe AS, metabolic syndrome, and anemia, who sustained a fragility hip fracture with subtrochanteric extension, who underwent proximal femoral nailing. Her complex profile—ASA class 3, Revised Cardiac Risk Index intermediate risk (6.0%), and chronic conditions—underscored the need for hemodynamically stable anesthesia. A combined ultrasound-guided psoas compartment and parasacral sciatic nerve block with 20 mL ropivacaine 0.5% each was employed to circumvent risks of general anesthesia (myocardial depression, hypotension) and neuraxial techniques (sympathetic blockade). The psoas block targeted lumbar plexus for anterior/lateral coverage, while the parasacral block anesthetized sciatic nerves for posterior pain control. Sedation and anxiolysis were achieved using remifentanil (TCI minto model 0.5–0.8 ng/mL) and dexmedetomidine (0.4–0.6 mcg/kg/hr).Results Intraoperative hemodynamics remained stable throughout the surgery (SBP 120–130 mmHg, HR 70s). Postoperative pain (NRS 0/10) was adequately controlled with oral paracetamol and cox-2 inhibitor.Abstract P151 Figure 1Psoas compartment blockAbstract P151 Figure 2Parasacral sciatic nerve blockConclusions This case underscores combined psoas compartment block and parasacral sciatic nerve block as an effective strategy for managing frail patients whose condition requires avoidance of sharp fluctuations in the patient’s hemodynamics. By optimizing analgesia while mitigating cardiovascular risks, enhance perioperative safety, advocating for the techniques broader adoption in fragility fracture surgery.