# A Walk to Remember: Anesthetic Management of a Supercentenarian with Hip Fracture and Review of Literature

## TL;DR

This paper presents the successful anesthetic management of a 111-year-old man undergoing hip fracture surgery and reviews strategies for treating supercentenarians.

## Contribution

The paper provides a rare case report and literature review on anesthetic techniques for supercentenarians undergoing surgery.

## Key findings

- A combined spinal-epidural anesthesia with ultra-low-dose bupivacaine was safely used in a 111-year-old patient.
- Multimodal pain management and proactive hemodynamic optimization enabled early mobilization and discharge.
- The case highlights that age alone should not prevent surgery if guided by physiological assessment and evidence-based techniques.

## Abstract

The steadily increasing global life expectancy has led to an unprecedented rise in the number of centenarians and supercentenarians (over 110 years) presenting for surgical procedures. While this demographic shift is a triumph of modern medicine, it also poses unique perioperative challenges. Such populations represent an extreme physiological spectrum, characterized by limited organ reserve, altered pharmacokinetics, and unpredictable responses to anesthetic agents. Yet, they often present with urgent surgical conditions such as hip fractures, where timely intervention is critical to preserve function and independence. The anesthetic management of such patients requires a meticulous, physiology-driven strategy that balances efficacy with safety while facilitating early mobilization to maintain independence. We report the anesthetic management of a 111-year-old man, the oldest trauma surgery patient at our institution, who underwent closed reduction and internal fixation of an intertrochanteric fracture.

This patient had no major comorbidities but carried the risk of extreme age-related frailty. We employed a combined spinal-epidural anesthesia (CSEA) technique with an ultra-low-dose intrathecal injection (0.6 mL of 0.5% heavy bupivacaine), customized according to our institutional age-dose protocol. A preoperative pericapsular nerve group (PENG) block facilitated pain-free positioning for the neuraxial anesthesia. Hemodynamic stability was proactively maintained with a prophylactic low-dose norepinephrine infusion, guided by a “mean arterial pressure ≈ patient’s age” principle. Postoperative recovery was supported with a supra-inguinal fascia iliaca (SIFI) block as a part of a multimodal, opioid-sparing strategy, embedded within our enhanced recovery after surgery (ERAS) protocol. This approach enabled mobilization by postoperative day 3 and discharge on day 7, a benchmark for functional recovery in a supercentenarian. No delirium or complications were observed at the 30-day follow-up.

This case, a true “Walk to Remember,” is contextualized by a literature review highlighting neuraxial anesthesia (low-dose spinal anesthesia, CSEA, and continuous spinal anesthesia {CSA}), peripheral blocks (PENG and SIFI), and proactive hemodynamic optimization in centenarians and supercentenarians. This is among the few documented reports of anesthesia in a supercentenarian worldwide. It reinforces that chronological age alone should not preclude surgery when careful physiological assessment, evidence-based anesthetic techniques, and multidisciplinary perioperative care guide management.