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Background and Aims Regional anesthesia techniques are important alternatives in patients with pre-existing cardiac disease. By reducing hemodynamic fluctuations and surgical stress response they are less impairing for cardiac function.

Methods A 75-year-old, ASA IV female patient proposed for gamma nail fixation of intertrochanteric fracture with medical history relevant for left ventricular pseudoaneurysm secondary to recent myocardial infarction treated with primary angioplasty and acute peripheral artery disease managed with intra-arterial thrombolysis. Due to the patient’s comorbidities, it was decided to perform a low-dose single-shot spinal anesthesia combined with infrainguinal fascia iliaca block. Informed consent was obtained.

Results Standard monitoring was started, an arterial line placed and oxygen delivered by nasal cannula. A ultrasound guided infrainguinal fascia iliaca block was performed using 30ml of 0,375% ropivacaine. The patient was then moved to the operating table and placed in left decubitus for spinal anesthesia. After aseptic preparation, a 27G spinal needle was inserted at L3-L4 level and 6 mg of isobaric bupivacaine and 2 micrograms of sufentanil were administered. The level of sensory block was observed in T12 and motor blockade was complete on both lower limbs. The surgical procedure lasted for 40 minutes with hemodynamic stability throughout. The patient was transferred to the ICU for postoperative monitoring, where she stayed for 24 hours hemodynamically stable and with good pain control.

Conclusions Elderly and fragile patients are an anesthetic challenge. Regional anesthesia techniques are a great option due to their lower cardiovascular impact, effective postoperative analgesia and no consequence on cognitive function.