Ultrasound Guided Pericapsular Nerve Group and Lateral Femoral Cutaneous Nerve Block for Perioperative Analgesia in a Patient with Ischemic Heart Disease on Anticoagulants Posted for Corrective Hip Surgery

Abstract

Introduction : Ultrasound guided pericapsular nerve group block is an approach to block the articular branches of femoral, obturator and accessory obturator nerves that supply the anterior hip capsule and has been found to provide good perioperative analgesia. Case Report: An 86 year old male, who suffered fracture neck of femur after an alleged slip and fall, was posted for emergency corrective surgery. Perioperative evaluation revealed ischemic heart disease, status post PTCA with preserved LV systolic function and on oral anticoagulant rivaroxaban and antiplatelet medication clopidogrel. Coagulation profile was within acceptable range. Cardiac Troponins and Brain Natriuretic peptide (BNP) were measured. General anesthesia was planned to this patient in view of relative contraindication to central neuraxial block i.e. patient being on anticoagulants. Perioperative analgesia was provided with ultrasound guided pericapsular nerve group block for fracture site pain and lateral femoral cutaneous nerve block for surgical incision pain. Patient had stable hemodynamic with improved pain score (VAS & lt; 3) in the immediate postoperative period. There was no evidence of post-operative delirium and perioperative myocardial injury. Conclusion : Ultrasound guided superficial regional nerve group block such as Pericapsular nerve group block, lateral femoral cutaneous nerve block can provide effective postoperative analgesia in patients where central neuraxial blocks are contraindicated. Keywords : Anticoagulants, Hip fracture, Regional anesthesia. Key Messages: Acute pain management in elderly patients is quite challenging to anesthesiologists due to medical comorbidities such as ischemic heart disease patients who experience greater pain are at increase risk in post operative period and patients on anticoagulants where central neuraxial blockade are contraindicated. Perioperative analgesia helps in intraoperative hemodynamic stability and post operative analgesia.