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Background and Aims Airway management in patients with head and neck malignancies is frequently complicated by anatomical distortion and a high risk of obstruction. In some cases, even awake intubation may be unfeasible due to the inability to advance the orotracheal tube. Regional anesthesia techniques may offer a safer alternative to general anesthesia. This case highlights the successful use of bilateral intermediate cervical plexus block (ICPB) and translaryngeal block for urgent tracheostomy in a patient with advanced hypopharyngeal cancer.Methods A 63-year-old male with a history of alcohol and tobacco use and hypopharyngeal squamous cell carcinoma (cT3N2bM0) presented with resting dyspnea and oral mucosal bleeding. Otolaryngologic assessment identified an ulcerated tumor of the right pyriform sinus, right vocal cord paresis, and severe glottic narrowing. Due to imminent airway compromise, urgent tracheostomy was indicated. An ultrasound-guided bilateral ICPB was performed with 5 mL of 0.75% ropivacaine on each side. Also, we performed an ultrasound-guided translaryngeal block with 4 mL 2% lidocaine. No sedation was administered.Results A sensory block covering dermatomes C2 to C4, along with the trachea and lower larynx, was successfully achieved. The procedure was completed without complications, and the patient remained awake and comfortable throughout. The postoperative course was uneventful, with no pain reported. On the fifth postoperative day, the patient was transferred to a specialized oncology center for ongoing care.Abstract P116 Figure 1Nasopharyngolaryngoscopy revealed active bleeding from a tumor in the right pyriform sinus and significant glottic narrowingConclusions Bilateral ICPB combined with a translaryngeal block provided adequate anesthesia and patient comfort during urgent tracheostomy without the need for general anesthesia or sedation. This approach represents a safe and effective alternative for urgent tracheostomy in patients with compromised airways.