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Background and Aims Regional Techniques are preferred during pregnancy for surgeries due to increased risks of general anaesthesia. We discuss a case of a 28-year-old nulliparous woman at 32 gestational weeks (H:160cm, W:70Kg) presenting with a subcapital hip fracture.

Methods Total Hip Arthroplasty was planned under epidural analgesia. Patient was in supine position with extended hip and externally rotated reporting VAS pain scores 09-10. Under ASA monitoring,Suprainguinal Fascia Iliaca (SFI) was identified using a high frequency linear ultrasound probe placed in a transverse orientation over femoral crease and laterally after palpating the Anterior Superior Iliac Spine (ASIS).Using in-plane technique, the block needle was inserted under the inguinal ligament. After negative aspiration, 20mL Ropivacaine 0.2% was administered deep to the fascial plane. Patient was able to sit for an epidural catheter which was sited with LOR technique. A test dose of 3mL Lidocaine 2% was followed with 5 mL of 0.75% Ropivacaine at 30 min.The THR was successfully concluded at 90 minutes.

Results SFI block to femoral and lateral femoral cutaneous nerves enable the patient to sit for the epidural. Maternal haemodynamic stability and uteroplacental blood flow were maintained and foetal hypoxia was avoided. Post-operatively, no further analgesia was required and the epidural catheter was removed after 24 hours. Following discharge after 3 days, she gave birth at term.

Conclusions Regional Anaesthesia is effective and safe for joint arthroplasty during the third trimester of pregnancy.