Xiaonan Liu,* Linlin Li,* Junfeng Liu, Yiming Dong

Department of Anesthesiology, The Second People’s Hospital of Dongying, Dongying, Shandong Province, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Junfeng Liu, Department of Anesthesiology, The Second People’s Hospital of Dongying, No. 28, Changchun Road, Dawang Town, Guangrao County, Dongying, Shandong Province, 257335, People’s Republic of China, Tel +861395600448, Email liujunfeng_9@163.com Yiming Dong, Department of Anesthesiology, The Second People’s Hospital of Dongying, No. 28, Changchun Road, Dawang Town, Guangrao County, Dongying, Shandong Province, 257335, People’s Republic of China, Email dong25ym@outlook.com

Background: Regional anesthetic techniques for hip fracture are critical for pain control, reducing perioperative adverse events, and minimizing postoperative opioid use. This case series investigates the use of a novel triple-block protocol—ultrasound-guided pericapsular nerve group (PENG) block, lateral femoral cutaneous nerve (LFCN) and sacral plexus blocks—in patients with hip fractures, focusing on its feasibility as an anesthetic strategy for high-risk hip fracture patients.
Case Presentation: Five frail elderly patients with significant comorbidities and contraindications to neuraxial anesthesia underwent bipolar femoral head replacement surgery. Primary outcomes included anesthesia quality (0-3 scale: poor, acceptable, good, excellent) and postoperative analgesia. Secondary outcomes encompassed surgical conditions, complications, and patient satisfaction.
Results: These combined blocks provided effective analgesia (Visual Analog Scale, [VAS] scores of 0-1 at PACU discharge) and preserved quadriceps motor function (Medical Research Council [MRC] scale 4-5). Surgical conditions were rated “excellent” in four cases and “acceptable” in one. Postoperative sufentanil consumption was low (36-83 μg via patient-controlled analgesia [PCA]). Complications included one case of surgical site dehiscence (requiring reoperation) and transient dizziness.
Conclusion: This triple-block technique offers comprehensive analgesia for high-risk hip fracture patients or those with contraindications to neuraxial anesthesia, enabling early mobilization and reducing opioid reliance. Larger randomized trials are warranted to confirm these findings.

Keywords: pericapsular nerve group block, lateral femoral cutaneous nerve block, sacral plexus block, hip fractures, geriatric anesthesia