Background and Aims The majority of the ophthalmic surgeries are done in day case setting in elderly patients with multiple co-mobilities. It is fundamental that the patient can lay flat comfortably during surgery with no movement if regional anesthesia (RA) is planned.

Methods We report a vitreoretinal surgery with RA.

Results A 80 year-old women, ASA III with severe thoracic kyphosis because of bone tuberculosis causing restrictive pulmonary syndrome, bronchiectasis and sleep apnea with nighttime BiPAP and oxygen therapy during the day, was proposed to vitrectomy because of retinal detachment.

On account of the risk of general anesthesia (GA) in this patient, we decided to perform a peribulbar block and a subtenon block with 1% ropivacaine, 3,5 ml and 3 ml respectively. To achieve adequate positioning there was a need to use multiple pillows until the patient was comfortable, and the surgeon satisfied. To complement the local anesthetic, we used a light sedation with alfentanil.

The surgery lasted two hours and 10 minutes, without complications.

Conclusions In our case, the patient had multiple respiratory co-morbidities with high risk of complications in case of a GA. She also had a severe kyphosis with need of creativity do achieve adequate positioning. With a good communication with the nursing team and the patient we were able to attain a good operation field. Even thought, there are descriptions of the use of only one of the above blocks to perform RA in vitreoretinal surgery, with both blocks the patient is more comfortable and more likely to tolerate a long surgery.