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Background and Aims Anaesthetic management of patients with severe sepsis requiring urgent surgery pose significant challenges. This case reports the perioperative management of a 73-year-old female with multiple comorbidities (hypertension, type 2 diabetes mellitus, osteoarthritis, Heavy smoker, respiratory sepsis, COPD) who sustained a Tri malleolar ankle fracture with moderate displacement. She required an urgent orthopaedic intervention to prevent limb compromise.Methods The patient presented with an ankle fracture and respiratory sepsis (fever, productive cough, widespread crackles, hypoxia requiring oxygen and broad-spectrum antibiotics). Investigations revealed CRP 263 mg/L, WCC 52 x10 9/L (neutrophils 48 x109/L), and pneumonia on chest X-ray. Attempted manipulation under sedation by surgeons in A&E failed, necessitating urgent theatre intervention due to limb compromise. General anaesthesia (GA) was high-risk due to chest condition, and spinal anaesthesia was contraindicated due to severe respiratory sepsis. Therefore, a regional anaesthetic approach was chosen. Ultrasound-guided popliteal sciatic and saphenous nerve blocks with levobupivacaine (0.25% and 0.5%) were performed. For anxiolysis, she received 25 mcg fentanyl and 0.5 mg midazolam. Closed reduction was successfully achieved under regional anaesthesia. ORIF was deferred until sepsis was optimized.Results Peripheral nerve blocks provide safe and effective anaesthesia in septic, high-risk patients, minimizing systemic complications and avoiding airway intervention. However, with strict asepsis and US guided approach, the blocks were performed safely and successfully. In addition, delaying ORIF ensured optimal infection control before definitive fixation.Abstract P119 Figure 1Ankle xrayConclusions Regional anaesthesia, particularly peripheral nerve blocks, offers a viable alternative to General or spinal anaesthesia, emphasizing a multidisciplinary, patient-centred approach for improved outcomes in complex cases. All trainees need to be taught PLAN-A, RAUK blocks as per the RCOA curriculum recommendations. By undertaking this procedure under regional block, avoided patient limb compromise. RA-UK PLAN -A blocks workshop is now regularly taught in our institute for all the trainees and anaesthesia fellows .