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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionBackground and Aims This case report describes the anesthetic management of a child with Congenital insensitivity to pain with anhidrosis (CIPA)undergoing hollow nail internal fixation for a femoral neck fracture. Given the patient’s unique physiological challenges, we used ultrasound guided femoral nerve block and lateral femoral cutaneous nerve block to avoid the risks associated with general anesthesia or neuraxial anesthesia.Methods A high-frequency linear transducer was positioned parallel and perpendicular to the inguinal ligament, the femoral nerve appeared , using the inplane approach technique, a 22G needle was advanced from lateral to medial, approaching the femoral nerve, 10 mL of 0.5% ropivacaine was administered near the femoral nerve. The transducer was slightly moved laterally in the inguinal region, show the anterior superior iliac spine, the anterior inferior iliac spine, and the iliopsoas muscle. Using the in-plane approach technique, the 22G puncture needle was advanced from medial to lateral aspect of the anterior superior iliac spine and the superficial layer of the iliopsoas muscle. Then 5 mL of 0.5% ropivacaine was injected to block the lateral femoral cutaneous nerve.Results This case contributes to the medical literature by demonstrating a safe and effective anesthetic strategy in a pediatric CIPA patient, highlighting the potential of regional anesthesia techniques as a viable alternative to general anesthesia or neuraxial anesthesia in such high-risk cases.Abstract P145 Figure 1The CIPA patient’s nails showed deformities with ulcerationsAbstract P145 Figure 2The CIPA patient’s lower limbs exhibited multiple skin scars due to injuries and burnsConclusions This case report highlights the successful use of ultrasound-guided femoral and lateral femoral cutaneous nerve blocks in a pediatric CIPA patient undergoing femoral neck fracture surgery. This approach offers a safe alternative to general anesthesia, minimizing risks associated with autonomic dysfunction. It provides new insights into anesthetic management for CIPA patients, with benefits such as reduced opioid use and improved hemodynamic stability.