Background and Aims Rectus sheath block (RSB) is a trunk block indicated for postoperative analgesia in minor surgical interventions. This case report describes the performance of RSB as the sole perioperative anesthetic technique to a patient with a difficult airway undergoing open surgical gastrostomy.

Methods We present the case of a 76-year-old, male patient undergoing open surgical gastrostomy so that enteral nutrition could be accomplished. The patient suffered from maxillofacial cancer. He had undergone a major maxillofacial surgery and 32 cycles of radiotherapy to the head and neck area. His airway was characterized as difficult, as he presented with a mouth opening of 1cm and the structures of the upper airway were deformed. Our goal was to avoid general anesthesia and endotracheal intubation. We performed a bilateral RSB as the sole perioperative anesthetic technique with ultrasound guidance at T8 level, administering ropivacaine 0,5% and dexmedetomidine. When anesthesia of the surgical field was confirmed, the surgical procedure started and was completed without complications, with the patient remaining hemodynamically stable.

Results The bilateral RSB succesfully offered intraoperative anesthesia as well as sufficient postoperative analgesia to the patient.

Conclusions Trunk blocks are considered to be one of the cornerstones of modern anesthesia practices and can help the anesthesiologist provide a safe and stable anesthesia to high-risk patients. In our case, the performance of bilateral RSB to a patient with difficult airway undergoing open surgical gastrostomy, helped to completely avoid general anesthesia and also contributed to the patient’s post-operative analgesia, increasing his satisfaction.