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Background and Aims Raynaud phenomenon with digital ischemia is a debilitating manifestation of systemic sclerosis (SS) particularly in pediatric patients, where treatment options are limited and often inadequate. We present the case of a 15-year-old female with a diagnosis of SS admitted to hospital with severe ischemic, neuropathic pain in both hands, with dry gangrene of the left 5th digit and ischemic changes in the right index finger. The patient was refractory to multimodal regimen including low dose ketamine infusion, hydromorphone infusion, celecoxib, amitriptyline, gabapentin, magnesium and enteral clonidine. She was reporting severe pain 7–8/10 with severe sleep disturbance.Methods The acute pain service decided to proceed with regional anesthetic technique, to deliver analgesia and peripheral vasodilation. The patient had bilateral ultrasound guided infraclavicular nerve catheters placed under anesthesia. Given concerns for potential respiratory compromise with bilateral brachial plexus blocks, the nerve catheters were only bolused after the patient was awake after anesthesia. 2% lidocaine was injected with excellent nerve blockade and no respiratory issues.Results The patient reported immediate relief, with only mild pain in bilateral hands. 0.1% bupivacaine infusion was started at 5 ml/hr and by the following day ketamine and hydromorphone infusions were weaned off. On day 6, the catheters were discontinued and patient remained comfortable without recurrence of severe pain. At the time of discharge, her pain was mild and she was able to be discharged home. On follow-up at 30 days, patient reports resumption of pre-admission activities with pain scores no higher than 3/10, reporting that the nerve block helped break her severe pain episode.Abstract P104 Figure 1Bilateral infraclavicular nerve cathetersAbstract P104 Figure 2Digital necrosis of left finger secondary to systemic sclerosis and Raynaud’s phenomenonAbstract P104 Figure 3Ischemia of right hand secondary to systemic sclerosis and Raynaud’s phenomenonConclusions Our case report highlights the novel and safe use of bilateral infraclavicular catheters in a pediatric patient to treat severe ischemic pain refractory to traditional systemic analgesics. With slow titration & low concentration of local anesthetics, patient had excellent pain relief with no respiratory issues.