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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 submissionApplication for ESRA Abstract Prizes : I apply as an Anesthesiologist (Aged 35 years old or less)Background and Aims Anesthetic safety in pregnant women is a constantly developing field, which is why anesthesiologists are put in difficulty when choosing the anesthetic method. Moreover, laparoscopic surgery is beginning to advance more and more compared to open surgery, providing multiple benefits such as early discharge from the hospital. The purpose of this case is to determine the safest way to administer anesthesia to a first-trimester pregnant patient undergoing laparoscopic cholecystectomy and also whether combined epidural and spinal anesthesia (CSE) is a feasible choice.Methods 37-years old primiparous patient, in the first trimester of pregnancy diagnosed with acute calculous cholecystitis for which emergency surgical intervention is required. Laparoscopic cholecystectomy under combined spinal and epidural anesthesia (CSE) is decided.. The doses used were 12 mg hyperbaric bupivacaine 0.5% for spinal anesthesia and 16 ml ropivacaine 0.75% for epidural. The intra-abdominal pressure under which the intervention was performed was 10 mmHg. Postoperative analgesia consisted of Ropivacaine 0.2% continuously on the epidural catheter and paracetamol 1 g if required.Results The postoperative analgesia provided was good, only one dose of paracetamol being required. PONV were not present. The patient was extremely satisfied because she was conscious during the surgery and interacted with the anesthetic and surgical team, this fact reducing her anxiety. Fetal Doppler ultrasound was performed both before and after surgery, which revealed no pathological changes. The patient is discharged after 24 hours from the hospital.Conclusions Laparoscopic surgery in regional anaesthesia is a feasible procedure in the first trimester of pregnancy. The advantages of neuraxial anesthesia compared to general anesthesia include: no airways manipulation, reduced PONV, a better postoperative analgesia with a minimum of drugs, a reduced risk of thromboembolic event and it is not harmful to the fetus. Our approach highlights a possible new gold standard for anesthetic technique in laparoscopic surgery in pregnant patients.