Introduction : Ultrasound guided pericapsular nerve group block is an approach to block the articular branches  of femoral, obturator and accessory obturator nerves that supply the anterior hip capsule and has been found to  provide good perioperative analgesia. Case Report: An 86 year old male, who suffered fracture neck of femur after an alleged slip and fall, was  posted for emergency corrective surgery. Perioperative evaluation revealed ischemic heart disease, status post  PTCA with preserved LV systolic function and on oral anticoagulant rivaroxaban and antiplatelet medication  clopidogrel. Coagulation profile was within acceptable range. Cardiac Troponins and Brain Natriuretic peptide  (BNP) were measured. General anesthesia was planned to this patient in view of relative contraindication to central  neuraxial block i.e. patient being on anticoagulants. Perioperative analgesia was provided with ultrasound guided  pericapsular nerve group block for fracture site pain and lateral femoral cutaneous nerve block for surgical incision  pain. Patient had stable hemodynamic with improved pain score (VAS & lt; 3) in the immediate postoperative  period. There was no evidence of post-operative delirium and perioperative myocardial injury. Conclusion : Ultrasound guided superficial regional nerve group block such as Pericapsular nerve group block,  lateral femoral cutaneous nerve block can provide effective postoperative analgesia in patients where central  neuraxial blocks are contraindicated. Keywords : Anticoagulants, Hip fracture, Regional anesthesia. Key Messages: Acute pain management in elderly patients is quite challenging to anesthesiologists due to  medical comorbidities such as ischemic heart disease patients who experience greater pain are at increase risk  in post operative period and patients on anticoagulants where central neuraxial blockade are contraindicated.  Perioperative analgesia helps in intraoperative hemodynamic stability and post operative analgesia.