A combined block of the lower extremity offers many advantages over spinal or epidural anesthesia, such as less hypotension, no bladder paralysis or postspinal headache, and fewer concerns regarding coagulation problems. Furthermore, the extent of sensory and motor blockade of the lower extremity achieved with a combination of a sciatic and a dorsal lumbar plexus nerve block, by using a peripheral nerve stimulator, is by all means comparable to a central nerve block when used for knee surgery. For the surgery distal to tuberositas tibiae, the popliteal sciatic nerve block, alone or combined with a saphenous nerve block is a reasonable choice; for foot surgery an ankle block is probably the best method, so far as regional anesthesia is considered. The choice of local anesthetics is mostly directed by the duration of the surgery but the attention should be paid to the possibility of systemic toxicity because combined proximal nerve blocks of the lower extremity frequently require amounts approximate to the maximal recommended doses. The increased time investment, the impossibility of blocking all nerves of the lower extremity from one injection site, and certain failure rate which have to be accepted are frequently raised as arguments against the use of peripheral nerve blocks for day surgery. However, by adequate explanation of the procedure to the patient, proper organization of the time-frame table, and home transportation facilities, most of traditional restraints regarding peripheral nerve blocks for ambulatory surgery can be overcome or even acclimated. Copyright © 2000 by W.B. Saunders Company