A Case of Combined Spinal-epidural Anaesthesia and Fascia Iliaca Compartment Block in an Elderly Patient with Multiple Co-morbidities: A Tailored Approach to High-risk Hip Fracture Surgery

Co-morbidities and frailty augment the physiological changes associated with ageing, making the elderly more susceptible to perioperative complications related to surgical interventions. With this in mind, the planning of anaesthesia management needs to be carried out with caution, aiming at risk reductions that would include cardiopulmonary instability, postoperative cognitive dysfunction, and neuromuscular complications. Authors hereby, report a case of an 83-year-old male patient who underwent orthopaedic surgery and bring to the fore the challenges encountered in perioperative management. The patient with multiple comorbidities was subjected to a detailed preoperative assessment using a comprehensive geriatric assessment. The anaesthetic approach was tailored to this patient with a reduction in drug doses, preference for Regional Anaesthesia (RA), and the use of neuroprotective agents. Intraoperatively, careful cardiopulmonary monitoring was facilitated. He received an epidural and spinal anaesthesia to decrease opioid use. Postoperative precautions were taken regarding delirium and pulmonary disorders. He stayed well postoperatively and was discharged to the rehabilitation centre for follow-up. Elderly patients have characteristic features and problems during anaesthesia. Proper management in the perioperative period involves thorough preoperative assessment, judicious selection of the chosen anaesthetic techniques, and appropriate postoperative vigilance. Any approach to managing the elderly patient undergoing anaesthesia and surgery should take into account a holistic approach to anaesthesia and surgical care, while keeping safety at the forefront and emphasising the improvement of prognosis for recovery in this fragile group.