Background and Aims Regional anesthesia, which includes peripheral nerve blocks, contributes to a multimodal analgesic approach. Iliac fascia block is an alternative or complementary analgesic technique for knee, thigh and hip surgery.

Methods 93-year-old man, ASA IV, with history of hypocoagulated atrial fibrillation, NYHA Class III heart failure, benign prostatic hypertrophy, hypertension, diabetes, dementia and dyslipidemia scheduled for femoral intramedullary nailing.

Given the patient‘s comorbidities and general condition, with his possible intolerance to the hemodynamic rebound produced by general or spinal anesthesia, the team decided to resort to iliac fascia block as an anesthetic technique.

Caregiver’s consent to anesthesia was obtained.

To perform the block, a suprainguinal ecoguided approach was used. A linear probe was placed immediately below the antero-superior iliac spine (ASIS). The ASIS was identified and the probe placed transversely and rotated towards the umbilicus. An out of plane technique and a 50 mm needle were used and 20 mL of 1.5% mepivacaine and 20 mL of 0.375% ropivacaine were injected into the fascial illiaca.

The block was tested after 40’, with loss of sensitivity and muscle strength in the area of the LCFN and FN. The surgery began 50’ after the block. 15’ and 25’ into surgery, 30 mg and 70 mg of propofol were administered, respectively, due to patient agitation.

Results The surgery lasted 60’ and there were no complications or episodes of hemodynamic instability.

Conclusions The anesthetic approach used may be another option in hemodynamically unstable patients in which the most common anesthetic techniques incur an important hemodynamic rebound.