Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2021; 9(27): 8268-8273
Published online Sep 26, 2021. doi: 10.12998/wjcc.v9.i27.8268
Combined fascia iliaca compartment block and monitored anesthesia care for geriatric patients with hip fracture: Two case reports
Li Zhan, Yu-Jie Zhang, Jing-Xian Wang
Li Zhan, Yu-Jie Zhang, Jing-Xian Wang, Department of Anesthesiology, Lu’an Affiliated Hospital of Anhui Medical University, Anhui Medical University, Lu’an 237005, Anhui Province, China
Author contributions: Zhan L contributed conception, design and administrative support; Zhang YJ provided research materials and patients, data analysis and interpretation; Wang JX collected and sorted out data; All authors wrote, read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicting interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Li Zhan, MD, Doctor, Department of Anesthesiology, Lu’an Affiliated Hospital of Anhui Medical University, Anhui Medical University, No. 21 Wanxi West Road, Lu’an 237005, Anhui Province, China.
Received: June 13, 2021
Peer-review started: June 13, 2021
First decision: June 25, 2021
Revised: July 6, 2021
Accepted: July 27, 2021
Article in press: July 27, 2021
Published online: September 26, 2021

Major hip surgery usually requires neuraxial or general anesthesia with tracheal intubation and may be supplemented with a nerve block to provide intraoperative and postoperative pain relief.


This report established that hip surgical procedures can be performed with a fascia iliaca compartment block (FICB) and monitored anesthesia care (MAC) while avoiding neuraxial or general anesthesia. This was a preliminary experience with two geriatric patients with hip fracture, American Society of Anesthesiologists status III, and with many comorbidities. Neither patient could be operated on within 48 h after admission. Both general anesthesia and neuraxial anesthesia were high-risk procedures and had contraindications. Hence, we chose nerve block combined with a small amount of sedation. Intraoperative analgesia was provided by single-injection ultrasound-guided FICB. Light intravenous sedation was added. Surgical exposure was satisfactory, and neither patient complained of any symptoms during the procedure.


This report showed that hip surgery for geriatric patients can be performed with FICB and MAC, although complications and contraindications are common. The anesthetic program was accompanied by stable respiratory and circulatory system responses and satisfactory analgesia while avoiding the adverse effects and problems associated with either neuraxial or general anesthesia.

Keywords: Fascia iliaca compartment block, Monitored anesthesia care, Geriatric, Hip fracture, Ultrasound-guided, Case report

Core Tip: In clinical practice, we may encounter some elderly patients with many complications. As both general anesthesia and neuraxial anesthesia have high risks and contraindications, we chose nerve block combined with small amount of sedation. In this report, we describe administration of fascia iliaca compartment block in combination with low dose intravenous anesthesia to two geriatric patients, with satisfactory anesthetic effect. Anatomical diagrams and ultrasound imaging can, at a glance, promote this technique.