Background: Awake nasotracheal fiberoptic intubation (FOI) is essential for managing patients with anticipated difficult airways, allowing continuous airway visualization and preserving spontaneous respiration. Although effective, awake FOI can be distressing, necessitating the use of regional anaesthesia to enhance patient comfort. Combined regional nerve blocks, targeting the glossopharyngeal, superior laryngeal, and recurrent laryngeal nerves, have shown promise in reducing patient discomfort and improving procedural outcomes. Methods: This prospective observational study involved 30 adult patients with anticipated difficult airways requiring awake nasotracheal FOI. All patients underwent combined regional nerve blocks using 10% lignocaine spray, injection2% and 4% lignocaine to anesthetize the targeted nerves. Hemodynamic parameters, intubation time, patient comfort, and satisfaction were assessed during and after the procedure. Results: Significant hemodynamic changes were observed during intubation, with heart rate, systolic, diastolic, and mean arterial pressures all increasing notably from baseline (p < 0.001). However, these parameters returned to near-baseline levels within 10 minutes post-intubation. The mean intubation time was 2.2 minutes. Most patients (56%) exhibited minimal discomfort, and 90% reported high satisfaction, indicating the procedure's effectiveness and tolerability. Conclusion: Combined regional nerve blocks during awake nasotracheal FOI are effective in managing anticipated difficult airways. The procedure results in transient hemodynamic changes, minimal patient discomfort, and high satisfaction, supporting its use as a safe and efficient method for airway management.