Background and Aims There are exceptional cases where both general and regional neuraxial anesthesia are contraindicated for specific patient groups (comorbidities and/or recent surgical interventions) posing, thus, a great challenge in the operating theater.

Methods We present the case of a 84-year-old multitrauma female patient who sustained an unstable fracture of L1vertebra, fractures of right pleurae 10th-12th, bilateral fractures of the tibial bones, as well as abdominal, non-life threatening, injuries. She underwent urgent splenectomy, suturing of the liver, lumbar decompression laminectomy, closed reduction and internal fixation of the left tibia fracture and casting of the right one. She was hospitalized, thereafter, in the intensive care unit. Four weeks later, the patient was candidate for arthrodesis of her right ankle due to its comminution. She was respiratory and hemodynamically stable, tetrakinetic after the spinal surgery, but with delirium and sluggishness. The preoperative laboratory status revealed pathological values of TSH 61.4 mlU/L, FT3 1.5 ng/dl, FT4 0.7 ng/dl, ruling out general anesthesia, as an anesthetic option.

Results The operation was planned and successfully executed only with peripheral nerve block with the patient awake. The procedure was facilitated with an ultrasound guided saphenous and popliteal/sciatic nerve block with utilization of 0.5% 10 ml and 20 ml ropivacaine respectively.

Conclusions This case report demonstrates that peripheral nerve blocks could be the only feasible and sustainable anesthetic technique in a lower limb operation and their usefulness should be underscored when the traditional types of anesthesia are contraindicated, not technically performed and/or when the operation cannot be postponed.