Background and aims Treatment crises are frequent in the elderly population, usually with comorbidities that may prolong the hospitalization of these patients. The great interest is a quick recovery, but with an efficient analgesia that allows an early mobilization of the patients.

Methods Case report

Results Patient is 91 years old, ASA II, who is presenting with left transtrocantical fracture, discrete mental and previous history of abdominal distension and nausea with the use of PCA morphine. The association was associated with blockage of the supinguinguinal iliac fascia associated with the PENG block before surgery, avoiding hemodynamic repercussions of the neuraxis, but maintaining the benefits and discussed regional anesthesia. 20 ml of lidocaine 2% + 4 mg of dexamethasone without iliac fascia and 20 ml of ropivacaine 0.375% + 6 mg dexamethasone were used in the PENG block, both of which were guided by ultrasonography. A sedation with fentanyl and propofol, and spontaneous ventilation with o2 catheter. Patient maintained with MAP >70 throughout the process, without reacting to the surgical stimulus. At the end of a period of time, the beginning and end of the operation were completed in the ICU, with high frequency for the 24-hour period. She presented a pain score in the hip region and thighs in the last 72 hours, with the walker walking the day after the surgery.

Conclusions Review of satisfactory surgical anesthesia, with postoperative analgesia and drastic reduction of opioid consumption, with a rapid recovery of the patient, operating with early disease, without major hemodynamic changes, as an option.