Ultrasound-guided Femoral Nerve Block for Positioning in a Parturient with Sickle Cell Disease and Hip Fracture: A Case Report

The anaesthetic management of parturients with sickle cell disease is fraught with significant challenges, with an increased perioperative risk of complications such as vaso-occlusive crisis, acute chest syndrome, and thromboembolism. An associated orthopaedic injury adds another layer to perioperative planning, demanding an individualised approach to maximise analgesia, enable appropriate positioning for anaesthesia, and ensure haemodynamic stability. This case discusses the anaesthetic management of a 22-year-old primigravida with sickle cell disease and hypothyroidism and a right femoral neck fracture who underwent elective caesarean section. Since positioning for neuraxial anaesthesia would be problematic due to pain and limited mobility, an ultrasound-guided femoral nerve block was performed using 15 mL of 2% lignocaine. This permitted the patient to be positioned in the sitting position for spinal anaesthesia without discomfort. Spinal anaesthesia was administered with 1.6 mL of 0.5% hyperbaric bupivacaine and 25 µg fentanyl, achieving a sensory block up to T6. The intraoperative course was uneventful, and haemodynamics were stable. A healthy newborn was delivered with good Apgar scores. Postoperative care involved adequate analgesia, hydration, oxygenation, and early prophylaxis for thromboembolism. The postoperative course was uneventful, with no sickle cell-related complications, and both mother and infant were discharged in stable condition. The case demonstrates the effectiveness of a combined regional anaesthesia technique in enhancing perioperative management in high-risk obstetric patients. The use of a femoral nerve block as an adjunct to spinal anaesthesia was a valuable, efficient, and safe procedure that minimised pain and enhanced the patient’s comfort, contributing to a favourable surgical outcome.