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Background and Aims In the last decade, the medical digital field has significantly evolved, making patient clinical history easily accessible via computer. However, operating room policies that emphasize high productivity often limit the time available for collecting comprehensive medical histories. The choice of anesthetic technique can be influenced by a patient’s bleeding history, highlighting the importance of patient anamnesis.

Methods An 89-year-old female with no significant past medical history was scheduled for a total hip replacement (THR). Despite her previous surgeries - bladder surgery and colonoscopy with polypectomy - being complicated by hemorrhagic shock, her preoperative blood work was normal. An immunohematology consultation did not suggest further preoperative investigation. After obtaining informed consent, an ultrasound-guided suprainguinal fascia iliaca (SIFI) block was performed using 30 mL of 0.5% ropivacaine, followed by total intravenous general anesthesia. Intraoperative blood loss was 1000 mL, causing hemodynamic instability that required ROTEM-guided blood components and vasopressors. The patient was then transferred to the post-anesthesia care unit with a recommendation for an immunohematology evaluation to investigate potential blood dyscrasias.

Results This case underscores the critical importance of patient anamnesis in predicting and managing potential intraoperative complications.

Conclusions Patient anamnesis must be thoroughly considered in all cases, as normal blood tests do not eliminate the risk of bleeding complications. The SIFI block is a safer alternative to neuroaxial blocks for THR in patients with a positive bleeding history. Further studies are needed to support these findings.