Unilateral sacral erector spinae plane block for hip fracture surgery

The provision of anaesthesia for hip fracture surgery in elderly and frail patients can be challenging, with potentially significant risks associated with both general and neuraxial techniques. Here, we report the use of a sacral erector spinae plane block as an alternative to conventional anaesthetic approaches for a frail 89-year-old woman with significant cardiovascular and respiratory comorbidity who underwent intramedullary nailing for a proximal femoral fracture. A unilateral injection of local anaesthetic at the intermediate crest of the second sacral vertebra resulted in bilateral sensory block of the T12 to S2 dermatomes. The technique did not result in hypotension or motor block of the limbs, and the surgery was completed uneventfully. Sacral erector spinae plane block warrants further investigation as an alternative to spinal and general anaesthesia for hip and lower limb surgery.