Epidural anesthesia and ultrasound-guided femoral nerve block in a patient with femur shaft fracture receiving combined anticoagulant treatment

With an ever increasing ratio of advanced age and cardiovascular disease in the population the anesthesiologists often come across patients for elective and emergency surgery, who are on one or multiple anticoagulants. Although the use of regional techniques is a preferred choice of anesthesia in suitable patients, some anesthesiologists prefer combing regional with general anesthesia and/or peripheral nerve blocks. Traditionally patients on anticoagulants have been opted out of regional or nerve block analgesia for fear of hematoma formation, but the recent upsurge in the use of ultrasound has increased the precision in the procedures and the confidence in the performers. This report describes the case of an old lady for lower limb surgery, who was on multiple anticoagulants, and she was successfully anesthetized using combined techniques.