{
  "abstract": "Application for ESRA Abstract Prizes : I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims Femoral neck fracture surgery is commonly performed under general or neuraxial anesthesia. However, patients with severe cardiopulmonary comorbidities are at increased risk of anesthesia-related complications. Regional anesthesia combined with sedation offers a safer alternative. Although femoral nerve block (FNB) and lateral femoral cutaneous nerve block (LFCNB) provide effective analgesia, previous studies report the need for supplemental opioids during surgical manipulation. The pericapsular nerve group (PENG) block, targeting articular branches of the femoral, obturator, and accessory obturator nerves, may enhance analgesia. We report a case managed with FNB, LFCNB, and PENG block under sedation, achieving effective anesthesia with minimal opioid use.Methods A 76-year-old woman with acute exacerbation of heart failure, bronchial asthma, chronic obstructive pulmonary disease (COPD), and vertebral spondylitis underwent internal fixation for a femoral neck fracture. Anesthesia was achieved with dexmedetomidine sedation combined with ultrasound-guided FNB, LFCNB, and PENG block.Results No pain was reported during skin incision or femoral manipulation. Mild discomfort during incision of the tensor fasciae latae muscle required a single intravenous administration of 25 μg fentanyl. No further opioid supplementation was needed. Compared to previous reports requiring cumulative fentanyl doses of 50–100 μg, this case demonstrated that opioid requirements could be minimized to a single microdose, reducing the risks of respiratory depression and hemodynamic instability.Abstract P141 Figure 1Postoperative X-ray imagesConclusions The PENG block likely contributed to effective blockade of both femoral and accessory innervation of the proximal femur. Additional blockade of the superior gluteal nerve might have further reduced the need for opioids. Combining peripheral nerve blocks with sedation presents a promising strategy to enhance safety and minimize opioid-related adverse effects during femoral neck fracture surgery in high-risk patients.",
  "authors": [
    {
      "affiliations": [
        "Anesthesiology, Tokyo Women’s Medical University, Tokyo, Japan"
      ],
      "name": "Nana Kagaya"
    },
    {
      "affiliations": [
        "Anesthesiology, Tokyo Women’s Medical University, Tokyo, Japan"
      ],
      "name": "Tomoki Sasakawa"
    },
    {
      "affiliations": [
        "Anesthesiology, Tokyo Women’s Medical University, Tokyo, Japan"
      ],
      "name": "Yasuko Nagasaka"
    }
  ],
  "title": "P141 Combined PENG, femoral, and lateral femoral cutaneous nerve blocks provide effective opioid-sparing anesthesia for hip fracture surgery",
  "uid": "3baa07db-f38b-5f14-9c1b-325079f19bc4"
}