Case report Psoas compartment block for operative reduction of hip fracture in a patient with increased intracranial pressure due to inoperable brain tumor ☆,☆☆ Alexander Avidan MD (Senior Staff Anesthesiologist) ⁎ , Keren Cohen MD (Staff Anesthesiologist) Department of Anesthesiology and Critical Care Medicine, Hadassah—Hebrew University Medical Center, Ein Karem, Jerusalem, 91120 Israel Received 8 July 2009; revised 12 April 2010; accepted 16 June 2010 Keywords: Anesthesia, regional; Psoas compartment block; Brain tumor; Intracranial pressure Abstract General and neuraxial anesthesia in patients with increased intracranial pressure (ICP) who present for non-neurosurgical surgery may cause life-threatening changes in ICP, with possible fatal outcome. Peripheral nerve blocks may be a safe alternative technique for limb surgery. The successful use of psoas compartment block for operative reduction of a hip fracture in a patient with increased ICP due to an inoperable brain tumor is presented. © 2011 Elsevier Inc. All rights reserved. 1. Introduction Anesthetizing patients who have increased intracranial pressure (ICP) due to brain tumors and who present for non- neurosurgical surgery is a challenging task. General and neuraxial anesthesia may cause life-threatening changes in ICP, with possible fatal consequences. Peripheral nerve block may be a safe alternative technique in these patients. The successful use of a psoas compartment block for operative reduction of a hip fracture in a patient with inoperable brain tumor and increased ICP is presented. 2. Case report An 82 year old woman admitted to the hospital with a closed fracture of the right femoral neck. Several months before admission, the patient was diagnosed with a large, inoperable brain tumor. She was conscious, but she had difficulty in walking. A computed tomographic scan showed a large left parietal/temporal high-grade glioma. The tumor caused midline shift, obstruction of intraventricular foram- ina, and an enlarged right ventricle. In addition, signs of elevated pressure on the brainstem with uncal herniation were seen. Otherwise, the patient was healthy. On the day of admission, the patient fell and suffered from a right intertrochanteric fracture. Severe pain in the right hip made mobilization impossible. The goal of surgery was to allow the patient to spend the few remaining weeks of her life pain- free with the ability to mobilize. Percutaneous compression plate (PCCP) [1], a minimally invasive surgical technique, was chosen for operative reduction of the fractured femur. Psoas compartment block ☆ Supported by institutional and/or departmental sources only. ☆☆ Conflict of interest: The authors have no commercial association that might pose a conflict of interest with this manuscript. ⁎ Corresponding author. Tel.: +972 2 677 7111; fax: +972 153 50 857 3108. E-mail address: alex@avidan.co.il (A. Avidan). 0952-8180/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.jclinane.2010.06.012 Journal of Clinical Anesthesia (2011) 23, 307–309