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Background and Aims While general anesthesia is the standard approach for thyroidectomy, it may pose significant risks in patients with hypersensitivity to anesthetic agents. Regional techniques offer a safe alternative. We report a case of total thyroidectomy performed under regional anesthesia alone in a patient with confirmed morphinomimetic allergy.Methods We present the case of a 28-year-old female patient with asthma who was initially scheduled for total thyroidectomy due to a toxic nodule. During induction of general anesthesia in the first attempt, she developed acute urticaria and bronchospasm. The procedure was aborted, and subsequent allergologic investigations confirmed hypersensitivity to morphinomimetic agents. After multidisciplinary discussion, an opioid-free approach was mandated and the patient was rescheduled for total thyroidectomy under local anesthesia using the bilateral intermediate cervical plexus block technique (BICPB) with non-narcotic sedation , avoiding general anesthesia.Results The procedure was completed without complications. The patient remained hemodynamically stable, conscious, and comfortable throughout the surgery. She reported acceptable pain levels, and had an uneventful recovery with no signs of allergic reaction.Conclusions This case demonstrates that total thyroidectomy can be safely and effectively performed under regional anesthesia alone in patients at high risk for complications with general anesthesia.