Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 11 1 2025 01 01 116 121 Vijayalaxmi Biradar Department of Anaesthesiology, Bharati Medical College and Hospital, Katraj, Pune, Maharashtra, India. Shweta Konnur Department of Anaesthesiology, Bharati Medical College and Hospital, Katraj, Pune, Maharas Abhay Sancheti Department of Anaesthesiology, Bharati Medical College and Hospital, Katraj, Pune, Maharashtra, India. 2024 04 15 2024 04 24 High risk patients with multiple comorbidities, sepsis, poor cardiopulmonary reserve when posted for emergency below knee surgeries definitely pose challenges in terms of Anaesthesia. In this case series we highlighted the important role of ultrasound guided popliteal sciatic combined with adductor canal block as a sole anaesthetic technique for safe outcome in high risk cases having significant and multiple comorbidites. 10 cases with ASA physical status III and IV, aged 50-70 years scheduled for below knee surgeries were enrolled. All the patients received ultrasound guided popliteal sciatic nerve block with 8 ml of 2% Lignocaine with Adrenaline and 8 ml of 0.5% of Bupivacaine and 4mg Dexamethasone (1ml) (total volume 17 ml) and Adductor canal block with 8 ml of 0.5% of Bupivacaine. Adequate sensory and motor blockade required for surgery was achieved, with stable haemodynamic parameters throughout the procedure. No patient developed any serious complication in the perioperative period. Combination of the popliteal sciatic nerve and adductor canal block provide sufficient sensory and motor block with good hemodynamic stability for below-knee surgeries. When used on high-risk patients with numerous comorbidities, this anesthetic technique has the potential to save lives. https://aacc.tums.ac.ir/index.php/aacc/article/view/987