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Background and Aims One-act bilateral total hip arthroplasty is increasingly performed as it has a lower risk of major systemic complications and shorter operative time. The procedure may be done in general or neuroaxial anaesthesia, with or without peripheral nerve blocks. Postoperative pain management include NSAIRs, paracetamol, cox-2-selective inhibitors, opioids and nerve blocks. Peng block provides postoperative analgesia and early mobility. It is mostly used in combination with the lateral cutaneous nerve block, which covers the sensory system of the anterolateral part of the thigh.

Methods A 40-year-old patient with bilateral avascular necrosis, BMI 35, ASA II, was scheduled for simultaneous total hip arthroplasty. The surgery was performed in spinal anaesthesia with levobupivacain and intrathecal sufentanil. At the end of the first arthroplasty, the Peng with lfcn block was performed on the contralateral side, and after the procedure on the ipsilateral side, with 0.25% and 0.125% levobupivacain respectively. The patient was sedated with a target-controlled infusion of propofol at a concentration of 1 mcg/mL. The duration of surgery was four hours.

Results A verbal numeric pain rating scale was obtained for 2 hrs, 4 hrs, and 8 hrs postoperatively. The scores were 2, 3, and 6 when the patient received peroral oxycodone/naloxone, 10/5 mg tbl. On the first postoperative day, the patient denied significant pain and refused analgesics.

Conclusions One-act bilateral total hip arthroplasty can be safely performed under neuroaxial anesthesia combined with pericapsular nerve group block, lfcn block, and i.v. sedation. This anesthesia option can be considered when performing surgery on both hips simultaneously.