Background and aims Malnutrition and cachexia are frequent in head and neck cancer (HNC) patients. These complications occur as a result of the cancer but are worsened by surgery, radiotherapy or chemotherapy that further challenge oral intake but also airway obstruction.

Methods We present case of 82-year-old male with nasopharyngeal carcinoma, severe malnutrition following multimodality therapy and difficult airway. He was unable to consume solid foods and liquids, developing severe cachexia due to esophageal stricture, confirmed during an unsuccessful gastroscopy. Refused by several hospitals, we opted for surgical gastrostomy under regional anesthesia, using epidural catheter placed T10/T11 and continuous 5% bupivacaine.

Results The procedure was uneventful and pain free. The epidural catheter was removed on the 2nd postoperative day; patient discharged on the 4th postop day, with functional gastrostomy. First follow up showed increase in body weight.

Conclusions Regional anesthesia and surgical gastrostomy can be successfully performed in a frail geriatric patient when the underlying disease cause severe airway obstruction.