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Background and Aims Pelvic and acetabular fractures are complex injuries, often due to high-energy trauma, associated with substantial pain, morbidity, and blood loss. Pain management in the emergency setting, including post-surgery, is frequently inadequate, with many patients relying mainly on opioids, which carry risks of adverse effects and long-term dependence. Multimodal analgesia and regional anesthesia (RA) techniques—such as fascia iliaca compartment block, erector spinae plane block (ESP), and quadratus lumborum block (QLB)—are emerging as promising tools to improve pain control and reduce opioid use. Strong evidence specific to pelvic and acetabular fractures remains limited.Methods This prospective, single-center, pilot study evaluates the effectiveness of regional anesthesia techniques in managing pain following surgery for pelvic and acetabular fractures. Conducted at CTO Hospital in Turin, Italy, the study includes patients undergoing surgical treatment comparing multimodal analgesia alone or in association with RA techniques such as supra-inguinal fascia iliaca (SIFI) block, lumbar ESP block, and transmuscular QLB. Primary endpoints were pain scores (NRS) and opioid consumption in the acute and postoperative phases.Results Preliminary data on 49 patients showed a significant drop in opioid use in the first 24 hours after surgery in the group treated with RA techniques. Morphine equivalents at 24 hours were reduced (p = 0.0406) in 23 patients who received RA blocks. Pain scores remained low and comparable between groups. Motor block rarely occurred in RA patients (17%). No significant differences were observed in hospital stay or pain persistence at 30, 60, and 90 days.Abstract EP165 Figure 1Morphine equivalents at 24 hrs in patients after perlvic/acetabular fracturesConclusions In this ongoing pilot study Regional Anesthesia techniques showed efficacy in reducing opioid requirements in the acute phase following pelvic and acetabular fractures surgery, supporting their integration into multimodal analgesia protocols. More robust data are necessary to corroborate this evidence, including more insights into which specific regional anesthesia technique best matches each surgical approach.