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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionBackground and Aims Regional Anaesthesia(RA)-nerve blocks+GA are usually performed for breast cancer surgery. But whenever patient’s medical condition dose not permit, nerve blocks become a boon and favourable oncological outcome of pain management in comparisons to volatile anaesthesia+opioid.Methods 76 year,female patient with ASA risk III (Height – 153 cm, weight -69 kg), having Invasive Ductal breast carcinoma (T2N0M0) of left breast posted for Simple Mastectomy and lymph node sampling. She is C/o Severe Advanced Interstitial Lung disease with fibrosis Emphysematous chest, Hypertension, Heart failure, DM. She is on steroids+ home oxygen with desaturations with Spo2 88–90% and Severe Pulmonary hypertension with RSVP- 82 mmofHg. Severe Reduction in DLCO. 6Minite Walking Test- Desaturation 76% (4 min). She is high risk for pulmonary complications from Positive Airway Pressure ventilation and GA with extreme care, if unavoidable/lifesaving surgery for barotrauma, volu-trauma. The patient had requested to RA with nerve blocks (Paravertebral + pectoral nerve blocks or thoracic epidural) with sedation. Informed Consent and MRC approval was obtained. All monitoring and Aseptic precautions, Ultrasound(US) guided Thoracic Paravertebral block (PVB) ( figure 1) was performed in sitting position at T3, T5, and T7 level with Curvilinear probe and identified triangular PVB (figure 1)with Lidocaine+adrenaline(1:200,000) 3 ml + 0.33%levobupivacaine 7 ml at each level after negative aspiration, pleura was pushed down. Pectoral blocks (figure 2) were performed between the Pec minor and serratus at 4th rib and between Pec Major and minor with 5 ml of 2%lignocaine +adrenaline + 0.33%Levobupivacaine 3 ml each. SSurgery was started after confirming the block effect. Sedation with Fentanyl 100 mcg+TCI Propofol of 0.5–1 mcg/ml. Surgical Duration was 1 hr 40 min. Patient was very comfortable during operation and postoperatively(NRS >3).Abstract P169 Figure 1PVB blockAbstract P169 Figure 2Pectoral blocksConclusions Whenever a medical condition of the patient cannot allow for GA, Multiple level nerve blocks can be a boon and act as rescue when expertise available.