Background and Aims Hip has a complex innervation and therefore it is a challenge to anesthetize it solely with peripheral nerve blocks. There are just a few cases described in literature where PENG block was used with anaesthetic goals and, as far as we know, there is no description of the association of blocks here described.

Methods We describe a female 82 year old patient, 72kg, with previous systemic hypertension and heart failure NHYA III with a femur fracture for an intramedullary nail. After monitoring, the following ultrasound guided nerve blocks were performed: PENG block (20 mL 0.5% Ropivacaine), Lateral Cutaneous Femoral Nerve (5 mL 0.5% Ropivacaine) and Obturator nerves at subpectineus plane (15 mL 0.5% Ropivacaine). Additional light sedation was achieved with dexmedetomidine IV (0,5mcg/kg/h) and ketamine (0,5mg/kg).

Results Surgery underwent smoothly without the need of any other anaesthetic drugs, patient sedated in RASS -3.

In the following 24h after surgery, there was no pain complaints or need of opioids.

Conclusions The anterior capsule of the hip is innervated by the lumbar plexus and the posterior capsule by the sacral plexus. The lateral side of the thigh is innervated by the lateral femoral cutaneous nerve, also part of lumbar plexus. Studies showed that the nociceptors concentrate mainly on the anterior capsule, thus the lumbar plexus is the main responsible for hip anaesthesia.

In this particular case, it was chosen to focus on lumbar plexus blocks through blocks mentioned previously.

By choosing this technique, we aimed to avoid approaching neuroaxial techniques or general anaesthesia preventing haemodynamic changes.