• EndersbyRyan V WRVW0000-0003-1471-1033Department of Anesthesiology, Perioperative and Pain Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, South Health Campus, 4448 Front St. SE, Calgary, AB, T3M 1M4, Canada. ryan., Joanna J Fifen, Marie-Eve Beauchemin-Turcotte, David H Goldstein, Esther C Y Ho, and IpVivian H YVHYDepartment of Anesthesiology, Perioperative and Pain Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, South Health Campus, 4448 Front St. SE, Calgary, AB, T3M 1M4, Canada..
• Department of Anesthesiology, Perioperative and Pain Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, South Health Campus, 4448 Front St. SE, Calgary, AB, T3M 1M4, Canada. ryan.endersby@gmail.com.
• Can J Anaesth. 2025 Jan 27.

PurposeWe report the use of a pericapsular nerve group (PENG) cryoneurolysis for longer-term analgesia in a patient with a hip fracture and severe medical comorbidities as an alternative to hip fracture surgery.Clinical FeaturesA frail but lucid and fully autonomous 97-yr-old female from an assisted living facility sustained a subcapital fracture of her right proximal femur following a ground level fall. She had significant comorbidities including end-stage respiratory disease. An attempt was made to proceed with a hemiarthroplasty; however, following a spinal anesthetic with 2 mL of 0.5% isobaric bupivacaine, she suffered significant respiratory compromise resulting in abortion of the surgical procedure. A multidisciplinary shared decision was made for palliative nonoperative management (P-NOM), and PENG cryoneurolysis was successfully performed. This significantly reduced the patient's pain on movement, which greatly enhanced and facilitated nursing care for the patient. She no longer required any opioid analgesia for the remainer of her stay, and residual pain was managed with regular acetaminophen. She was able to get up to standing with the help of the physiotherapist or nursing staff, who commented favourably on her improvement after cryoneurolysis. She continued to do well and was discharged to an assisted living facility seven days later.ConclusionOur case report shows that PENG cryoneurolysis can be used as an option for P-NOM in hip fracture surgery to provide significant and durable pain relief for those patients who may not be suitable for anesthesia and surgery.© 2025. Canadian Anesthesiologists' Society.

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