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Background and Aims Polytraumatized patients with cervical spine and facial injuries pose a challenge to anesthesiologists, especially regarding airway management. In such cases, regional anesthesia can be a safe and effective alternative, minimizing the risks of airway manipulation while preserving spontaneous ventilation.Methods A 23-year-old male sustained multiple injuries in a motorcycle accident, including cervical spine fractures (C5 and C7) requiring immobilization, a subcondylar mandibular fracture, and bilateral forearm fractures. Five days after admission, he underwent bilateral internal fixation of the forearms. He was classified as ASA II due to smoking and had preoperative anemia (Hb 7.8 g/dL). Anesthesia was provided via bilateral ultrasound-guided infraclavicular brachial plexus blocks. The toxic dose of local anesthetics was calculated according to his weight (80 kg with a normal BMI). A mixture of 10 ml of ropivacaine 0.5% and 10 ml of mepivacaine 1% was used for each block.Results The first block was performed on the left, where both radius and ulna were fractured ( figure 1). After 2.5 hours, the right-sided block was performed for distal radius fixation (figure 2), completed in 1 hour. Surgical anesthesia was achieved without sedation. On the following day, motor block had completely reversed.Abstract P147 Figure 1Left forearm surgical fixationAbstract P147 Figure 2Right forearm surgical fixationConclusions This case demonstrates the value of regional anesthesia in a patient with a potentially difficult airway due to cervical spine instability and mandibular fracture. It was possible to achieve great surgical anesthesia, safely, without the need to perform general anesthesia.