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Background and Aims A 59-year-old ASA IV patient with stage IV lung adenocarcinoma who suffered a pathological fracture of the distal right humerus. It was decided to do a closed reduction and internal fictation by traumatology with a T2 nail of the humerus. This patient was at a high anesthetic risk due to a history of bilateral PTE and pulmonary neoplasia that caused chronic respiratory failure with the need for oxygen therapy at home.

Methods In this case, regional anesthesia was performed under ultrasound control and neurostimulation: Interscalene block with 25ml of 0.375% levobupivacaine. Superficial cervical block with 10ml of 0.375% levobupivacaine. Suprascapular block with 10ml of 0.25% levobupivacaine. Intravenous sedation was performed in spontaneous breathing with nasal cannulas with capnography with: Remifentanil 0.05mcg/kg/min Propofol 3mg/kg/h

Results Throughout the intervention the patient remained hemodynamically stable and with oxygen saturations of 97-98%. Postoperative pain was well controled without the need of opioids.

Conclusions This case wants to demonstrate the importance of having regional anesthesia in fragile patients with high anesthetic risk. We see how even in surgeries where general anesthesia is usually required, with a good anesthetic plan we can avoid it and perform the surgery safely and with excellent postoperative pain control, also avoiding the abuse of opioids in these patients.