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Background and Aims The interscalene brachial plexus block is a widely used regional anesthesia technique for shoulder and upper arm surgeries. While the unilateral interscalene block is considered safe and effective in most patients, performing this block bilaterally poses significant risks. When applied bilaterally, this can lead to bilateral diaphragmatic paralysis, a potentially life-threatening condition. Additionally, the cumulative local anesthetic dose increases the risk of systemic toxicity.In select, life-threatening airway cases, its use may be reconsidered as a rescue anesthesia technique when general anesthesia is not feasible.Methods A 41-year-old male sustained a severe mine blast injury resulting in traumatic bilateral upper limb amputations at the upper third of the humerus and a comminuted mandibular fracture. The patient had recently been decannulated following prolonged mechanical ventilation via tracheostomy. Surgical intervention was planned for debridement and suturing of the amputation wounds. Due to the unstable airway (post-tracheostomy, fractured mandible, and distorted facial anatomy), general anesthesia was considered high risk.A bilateral interscalene brachial plexus block was performed under ultrasound guidance using reduced volumes of local anesthetic on each side to minimize the risk of diaphragmatic and systemic complications. The blocks provided adequate surgical anesthesia, and the procedure was completed successfully without adverse respiratory or cardiovascular events.Results After intravenous sedation with midazolam, bilateral interscalene brachial plexus blocks were performed under ultrasound guidance. Each side received 10 mL of 0.5% bupivacaine hydrochloride along with intravenous dexamethasone (4 mg). The patient remained hemodynamically stable, with no signs of respiratory distress, phrenic nerve involvement, or local anesthetic toxicity. Surgical wound suturing was completed successfully with excellent anesthetic effect.Conclusions This case demonstrates the potential life-saving role of bilateral interscalene brachial plexus block in extreme trauma scenarios with compromised airway anatomy. With appropriate precautions—including ultrasound guidance and careful dosing—bilateral blocks may be considered in select high-risk cases where general anesthesia is contraindicated.