Combined Supra-Inguinal Fascia Iliaca Compartment Block and Posterior Pericapsular Infiltration in Patients on Rivaroxaban Undergoing Pertrocanteric Fracture Surgery: A Case Series

Hip fractures in elderly patients on anticoagulants pose anesthetic challenges when neuraxial anesthesia is contraindicated. We report four cases of pertrochanteric fractures in patients receiving Rivaroxaban, managed with a supra-inguinal fascia iliaca (SIFI) block and posterior pericapsular infiltration, consistent with 2024 European Society of Regional Anestesia (ESRA) guidelines favoring superficial blocks. Adequate analgesia was achieved within 20 minutes, enabling surgery under mild sedation with stable hemodynamics. No opioids or postoperative complications were observed. This combined regional approach effectively covers anterior and posterior hip innervation and may offer a safe alternative for high-risk anticoagulated patients. Further studies are warranted to validate these findings.