Background and aims Neuroaxial anaesthesia is gold standard for lower extremity surgeries. Nowadays the introduction of ultrasound guided peripheral nerves blocks (PBN) changed the approach to orthopaedic surgery.

Methods This case series evaluates postoperative pain in 17 patients with femoral or knee fractures who received PNB because of contraindications to subarachnoid anaesthesia (eg. anticoagulation therapies, refusal). We performed femoral nerve block (levobupivacaine 0,5% 15 ml), obturators nerve block (levobupivacaine 0,5% 7 ml), lateral cutaneous nerve block (levobupivacaine 0.5% 3 ml) and sciatic nerve block (levobupivacaine 0,5% 20 ml) focusing on a lateral approach according to Sepolvere G and Tedesco M., in those affected by fractures where a posterior approach could be difficult or impossible.

Results In 2/7 cases a supplemental medication with Propofol 1 mg/kg/h was administered with spontaneous breathing. All received Midazolam 2–3 mg plus Fentanest 50mcg as a premedication. Antalgical post surgery therapy (Paracetamol 1000 mg; 3/day for the first 24h p.o.) was prescribed plus Ketorolac 30 mg if NRS>6. Only one rescue dose a day of Paracetamol 1000 mg was required after 24h. NRS mean (12h, 24h, 48h) was ≤2.

Conclusions Lateral approach of sciatic nerve block increases patient comfort and level of satisfaction, not requiring mobilisation. PBN could be considered as a valid alternative for patients who refuse or have contraindications to spinal anaesthesia, such as those in vascular surgery (over knee amputation), who require continuous anticoagulant treatment and where local anaesthetics can prevent from neuropathic pain obtaining an opioid sparing approach to pain management.