Proximal Femur Fractures (PFF) are common among the elderly and can lead to significant disability. Anesthesiological management typically involves Spinal

The anatomy of the sciatic nerve allows it to be blocked at different levels using various anesthetic approaches. However, for several reasons, performing these approaches may be challenging or disadvantageous in specific categories of patients, particularly in obese patients. The objective of this brief technical report is to describe a new technical approach to sciatic nerve block, designed to simplify the procedure for certain categories of patients and less experienced practitioners. Since 2010, more than 5000 procedures have been performed by both experienced anesthesiologists and novice trainees in several hospitals. The ultrasound lateral mid-shaft technique appears to be a safe and effective method for performing a sciatic nerve block, even in obese patients with significant subcutaneous fat and unclear ultrasound images. This approach is particularly beneficial given the various anatomical variations that can occur. By targeting the mid-thigh area, the ultrasound beam accesses anatomical structures that are more superficial, improving the technique’s efficacy. Various hospital groups have been performing this technique as a routine procedure, achieving a success rate of nearly 100%. This impressive success rate exceeds that of other conventional techniques documented in the literature. Additionally, there have been significant improvements in comfort and ease for anesthetists. This method allows the anesthetic to spread around the paraneural sheath, covering the posterior femoral cutaneous nerve. Finally, it is performed in the supine position without the need to mobilize the lower limbs, ensuring patient comfort, especially in cases of fractures or lower limb injuries. Further studies are needed to confirm these results.

Background: Anesthetizing frail patients for hip surgery is challenging; spinal (SA) and general anesthesia (GA) often cause hemodynamic instability. Traditional nerve blocks provide analgesia but rarely complete surgical anesthesia without motor block. We evaluate the clinical feasibility of the SAFE (Subarachnoid-alternative Anaesthesia For Endoprosthesis) protocol—combining Anterior Pericapsular Nerve Group (A-PENG), POsterior pericapsular Nerve Group (PONG), and Local Infiltration Analgesia (LIA) under intravenous sedation—as a primary anesthetic preserving motor function and avoiding SA/GA. Methods: This single-center retrospective series analyzed patients undergoing elective or trauma-related hip surgery using the SAFE protocol between September 2022 and April 2026. The primary outcome was success rate (completion without SA/GA conversion). Secondary outcomes included procedural timings, recovery room (RR) transit, and motor preservation. Variables are reported as medians [IQR]. Results: We included 48 patients (median age 83.5 years [IQR: 68.7–87.2]; 66.7% female) undergoing hip hemiarthroplasty (n = 28) or total hip arthroplasty (n = 20). The success rate was 100%, without SA/GA conversion or advanced airway management. Median anesthetic preparation and surgical durations were 55 [IQR: 50–76.2] and 85 min [IQR: 74–110], respectively. RR transit times (recorded for 35 patients) were brief (40 min [IQR: 34.0–67.5]). Crucially, lower-limb motor capacity was preserved in 100% of cases. The technique also proved opioid-sparing, substantially reducing postoperative opioid consumption. Conclusions: The SAFE protocol is a clinically feasible primary anesthetic strategy for hip surgery. By preserving motor function and enabling rapid fast-tracking, it aligns with ERAS pathways, offering a promising alternative to conventional anesthesia for elective and frail trauma patients. Randomized controlled trials are warranted to validate these outcomes.

Background: Peripherally inserted central catheters (PICCs) are widely used for medium- and long-term intravenous therapies but remain associated with mechanical and thrombotic complications, particularly during venipuncture and guidewire insertion. The growing use of Non-Operating Room Anesthesia (NORA) environments, where anesthesiologists frequently perform ultrasound-guided vascular access under conditions of limited resources and support, underscores the need for simple, reproducible, and inherently safe techniques. The objective of this technical note is to describe a modified ultrasound-guided venipuncture technique for non-tunneled PICC insertion, specifically developed for NORA settings, aimed at reducing procedure-related complications and preserving patient safety in routine clinical practice. Methods: The proposed technique consists of controlled intraluminal advancement of the needle tip (approximately 0.3–0.5 cm) under continuous ultrasound visualization, combined with progressive reduction in the insertion angle to achieve stable central intraluminal alignment before guidewire insertion. The technique has been applied in routine clinical practice across multiple Italian centers over the last two years, within a large multicenter real-world experience exceeding 5000 non-tunneled PICC procedures. Results: Based on real-world clinical observations, the systematic application of the technique was associated with a low incidence of early mechanical complications, including failed guidewire advancement, multiple venipuncture attempts, local pain, and hematoma formation. During standardized post-procedural ultrasound follow-up of the catheterized upper-extremity veins, no cases of catheter-related deep vein thrombosis were detected. Conclusions: This modified ultrasound-guided venipuncture technique represents a feasible and reproducible procedural refinement for non-tunneled PICC insertion in NORA environments. By enhancing intraluminal needle stability during guidewire advancement, it may contribute to improving procedural reliability and supporting patient safety in routine clinical practice. Further prospective and comparative studies are warranted to confirm these findings and define the generalizability of this approach.