Background and Aims Pediatric patients suffering from severe congenital syndromes require special attention and preoperative care, due to the complexity of their condition and potential complications that may arise during and after surgical procedures.

Methods Our case series involves five pediatric patients with different syndromes – Patau, Shprintzen-Goldberg, Larsen and Kabuki syndrome.Everyone except Patau patient were admitted at the Orthopedic and Trauma Department for hip and foot operation.Inguinal hernia repair has been performed at Patau patient.We performed popliteal blocks, PENG block,lumbosacral block,femoral block, dualTAP block. Each of the aforementioned syndromes is characterized by multiple anomalies of the central nervous system, cardiovascular, respiratory, gastrointestinal and skeletal systems, making it more difficult to intubate and ventilate the patient. Four patients underwent ultrasound-guided peripheral neural block procedures concomitantly with sedation prior to surgery. One patient was put under general endotracheal anesthesia and popliteal peripheral nerve block was performed prior to the operation.

Results All patients were hemodynamically stable with good ventilation mechanics throughout the surgical procedure, without pain,so there was no need for additional use of opioid drugs. Postoperatively, all the patients were fully awake, pain free, without nausea and vomiting, while maintaining excellent breathing mechanics and pattern.

Conclusions We can conclude that regional anesthesia i.e., peripheral nerve blocks can have a crucial role in perioperative care of patients with complex conditions, who have high chances of developing perioperative complications – difficult intubation and ventilation, aspiration, bronchospasm, laryngospasm, nausea, vomiting, pneumonia and others.