Pericapsular nerve group cryoneurolysis as an option for palliative nonoperative management of hip fracture in a patient with end-stage medical comorbidities.

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We report the use of a pericapsular nerve group (PENG) cryoneurolysis for longer-term analgesia in a patient with a hip fracture and severe medical comorbidities as an alternative to hip fracture surgery. A frail but lucid and fully autonomous 97-yr-old female from an assisted living facility sustained a subcapital fracture of her right proximal femur following a ground level fall. She had significant comorbidities including end-stage respiratory disease. An attempt was made to proceed with a hemiarthroplasty; however, following a spinal anesthetic with 2mL of 0.5% isobaric bupivacaine, she suffered significant respiratory compromise resulting in abortion of the surgical procedure. A multidisciplinary shared decision was made for palliative nonoperative management (P-NOM), and PENG cryoneurolysis was successfully performed. This significantly reduced the patient's pain on movement, which greatly enhanced and facilitated nursing care for the patient. She no longer required any opioid analgesia for the remainer of her stay, and residual pain was managed with regular acetaminophen. She was able to get up to standing with the help of the physiotherapist or nursing staff, who commented favourably on her improvement after cryoneurolysis. She continued to do well and was discharged to an assisted living facility seven days later. Our case report shows that PENG cryoneurolysis can be used as an option for P-NOM in hip fracture surgery to provide significant and durable pain relief for those patients who may not be suitable for anesthesia and surgery.