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Background and Aims Peripheral regional techniques, such as femoral nerve block or fascia iliaca block, are widely used to complement subarachnoid anesthesia in hip fracture surgery. However, local infection or anatomical constraints may contraindicate these approaches. The lumbar plexus block (LPB) offers an alternative pathway for analgesia while avoiding compromised areas. We present a case where LPB was successfully employed in a high-risk patient with an inguinal infection, highlighting its role as a viable option in complex scenarios.Methods An 87-year-old female with cardiac insufficiency (NYHA II/IV), atrial fibrillation, hypertension, obesity (grade 1), and chronic kidney disease (G3bA2) was proposed for intramedullary nailing of a subtrochanteric femoral fracture. Due to a contraindicating inguinal cutaneous infection, femoral/fascia iliaca blocks were deemed unsafe. Instead, a Shamrock technique LPB was performed under combined ultrasound and neurostimulation guidance, using a 100 mm needle and 20 mL of 0.2% ropivacaine. A subarachnoid block (9 mg bupivacaine + 0.002 mg sufentanil at L2-L3) was then performed as the primary anesthetic.Results The combined lumbar plexus and subarachnoid blocks provided adequate surgical anesthesia without complications. Surgery proceeded uneventfully, and postoperative pain was managed with paracetamol 1 g and tramadol 50 mg. The patient reported satisfactory pain control throughout recovery and was discharged on postoperative day 4.Conclusions When inguinal infection contraindicates femoral or fascia iliaca blocks, LBP can be a safe and effective alternative when performed with proper imaging and neurostimulation. This case underscores that LPB can be integrated into multimodal analgesia strategies in selected patients, offering reliable pain relief while minimizing infection risks.