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Background and Aims Carcinoid tumors are rare neuroendocrine tumors occurring in 2.5 to 5 cases per 100,000 of the population with 50% developing carcinoid syndrome. Perioperative management of carcinoid syndrome poses a challenge to anesthesiologists. Anesthetic considerations include avoiding factors that trigger release of the bioactive mediators such as avoiding hypotension and catecholamine release. The patient in this case report is a 48 year old male with a history of metastatic neuroendocrine tumor, carcinoid heart disease status post TV replacement and PV replacement, and severe carcinoid syndrome on Octreotide, Lanreotide, and Xermelo presenting for repair of femur fracture.Methods Patient was taken to the operating room and connected to standard ASA monitors. Patient was maintained on the perioperative Octreotide infusion as instructed by the patient‘s oncologist. Pre-induction arterial line was placed. Patient was given sedation with Versed and Fentanyl in order to tolerate left lateral decubitus positioning on the fractured hip. Sterile technique was performed and intrathecal catheter placed. Patient was then positioned supine. Isobaric bupivacaine 0.5% was dosed in 0.5 mL increments until the patient had satisfactory blockade for surgery. Patient was administered Hydrocortisone and Ondansetron prior to incision. Patient was maintained on a low dose propofol infusion throughout surgery.Results Patient remained hemodynamically stable in the perioperative period and was able to return to his floor bed. Patient was titrated off the Octreotide infusion on postoperative day 2 per Oncology recommendations and restarted on his home medications.Conclusions Depending on the type of procedure, intrathecal catheters can present an alternative option to maintain hemodynamic stability in combination with an Octreotide infusion in patients with severe carcinoid syndrome. The intrathecal catheter allows for slow titration of medication avoiding large hemodynamic swings that may be seen with single shot neuraxial anesthesia. This case highlights the importance of anesthetic planning and multidisciplinary coordination to maintain safe perioperative outcomes.