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Background and Aims We report a case of combining femoral and popliteal sciatic nerve blocks as the main anesthetic technique in an ASA III patient undergoing urgent reconstruction of an infected soft tissue defect of the left lower tibia using an autologous propeller flap.Methods A 46yo patient was admitted with COPD exacerbation, in need of oxygen supplementation and had recently(<12 h) received thromboprophylactic dose of LMWH. Due to the significant perioperative risk, ultrasound guided femoral and popliteal nerve blocks were elected as the main anesthetic technique. Preoperatively, under sterile conditions, with the patient in supine position, a high-frequency linear transducer was placed transversely over the femoral crease and the femoral nerve was identified. A femoral nerve block was performed, with 7 ml ropivacaine 0,5% and 3 ml lidocaine 2%. The transducer was again placed transversely at the popliteal fossa and popliteal artery, tibial and common peroneal nerve were visualized. After sliding the probe proximally, to identify the sciatic nerve in Vloka’s sheath, 25 ml of ropivacaine 0,5% and 5 ml lidocaine 2% were administered.Results Surgical anesthesia, with complete sensory and motor block of the left lower limb, was achieved. The surgery was well tolerated with IV sedation: 2 mg midazolam, 50μg fentanyl and propofol TCI (2μg/ml). No adverse effects were recorded.Abstract P120 Figure 1Ultrasound image of the needle path to nerve block the femoral nerveAbstract P120 Figure 2Sonoanatomy of the sciatic nerve at the popliteal fossaAbstract P120 Figure 3Reconstruction of a soft tissue defect of the left lower tibia using an autologous propeller flapConclusions The combination of femoral and popliteal sciatic nerve blocks was an effective regional technique, allowing this high-risk patient to undergo lower limb surgery, while avoiding general anesthesia and central neuraxial blockade.