Document resource
Background and Aims Hip fractures in elderly patients with severe aortic stenosis present significant anesthetic challenges, as neuraxial techniques carry risks of hemodynamic instability. This case demonstrates the use of ultrasound-guided combination of peripheral nerve blocks as the sole anesthetic approach in a high-risk patient.Methods A 90-year-old autonomous woman with severe aortic stenosis and dyslipidemia underwent surgery for a subcapital femoral fracture. Ultrasound-guided subgluteal sciatic, obturator, and fascia iliaca blocks were performed. Light sedation with midazolam was administered intraoperatively. The patient remained hemodynamically stable throughout the procedure, with no need for vasopressor support or complementary opioid analgesia.Results The avoidance of neuraxial anesthesia minimized the risk of hypotension and myocardial ischemia associated with severe aortic stenosis. This strategy enabled the surgery to be performed safely in a peripheral center without intensive care support, avoiding delays and transfer. The case highlights the versatility and safety of regional anesthesia, particularly in frail patients with high perioperative risk and in settings with limited resources.Conclusions Ultrasound-guided peripheral nerve blocks are a safe and effective alternative to neuraxial anesthesia in patients with severe aortic stenosis undergoing hip fracture surgery. This approach may reduce morbidity and mortality, and allows timely surgical management even in non-tertiary centers.