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Background and Aims The aim of this abstract is to present and analyze the effectiveness of lower leg analgesia using ultrasound-guided popliteal nerve block in pediatric patients with ankle fractures in the course of opioid free anesthesia and also to conduct a comparative clinical study compared to classical conventional intravenous analgesia, including opioids.Methods For period of 2 years we followed and compared 108 pediatric patients (7 y-17 y), undergoing surgical treatment of ankle fractures. All patients were ASA I. 35 (32.4%) children underwent ultrasound-guided popliteal nerve block with Lidocaine 1% + Ropivacaine 0.5% = 0.3 ml/kg with sedation (propofol V=2 mg/kg/h) and 78 (67.6%) children received general anesthesia (TIVA with propofol), including opioid analgesia (fentanyl). Intraoperatively analgesia is estimated by hemodynamics (objective criteria) and postoperatively-by hemodynamics (objective criteria) and standard pain scale scores - VAS, BOPS and PADS (subjective criteria).Results In the regional anesthesia group 6 children (17.15%) required single dose of additional intravenous opioid analgesia (fentanyl -.8–0.9 mcgr/kg) and the rest of 82.85% (29 children) were opioid free during the procedure.Abstract EP004 Figure 1Intraoperative analgesiaAbstract EP004 Figure 2Ultrasound image of target structuresAbstract EP004 Figure 3Double doughnut sign-typical for accurate spread of LAConclusions Opioid-sparing and opioid free anesthesia are becoming more and more tempting and desired as being safer and more comfortable both for the patients and the anesthesiologist. Ultrasound-guided regional blocks provides perfect conditions for the above mentioned. Nevertheless, pediatric patients still remain a challenge for performing regional nerve blocks from the perspective of cooperation, understanding and feedback. Our study revealed a safe profile of the ultrasound-guided popliteal nerve block in children with uneventful course, no side effects and prevalence of opioid free anesthesia.