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Application for ESRA Abstract Prizes:Background and Aims Severe aortic stenosis presents major anesthetic challenges during urgent non-cardiac surgery due to the high risk of hemodynamic instability and perioperative cardiac complications. The primary anesthetic concern is to maintain hemodynamic stability by avoiding hypotension, tachycardia, and abrupt changes in preload and afterload. Without prior cardiac intervention, choosing an anaesthetic technique with minimal cardiovascular risk is crucial. Peripheral nerve blocks may offer a safer alternative in this high-risk population.Methods We report the case of a 69-year-old female (ASA-PS IV) with symptomatic severe aortic stenosis (mean pressure gradient of 44 mmHg), awaiting surgical aortic valve replacement, who sustained a distal radius fracture requiring urgent surgical fixation. Standard ASA monitoring was applied, along with invasive blood pressure monitoring via a radial arterial catheter. To minimize cardiovascular instability and mitigate the risks associated with general anesthesia, a regional anesthetic technique was selected. An ultrasound-guided axillary brachial plexus block was performed using 25 mL of 0.5% ropivacaine.Results The peripheral nerve block provided effective surgical anesthesia, and the patient remained hemodynamically stable throughout the procedure, not requiring any hemodynamic support. The patient was admitted to an intermediate care unit for postoperative surveillance. Postoperative recovery was uneventful, with adequate analgesia and no cardiovascular complications were recorded.Conclusions Peripheral nerve blocks represent a valuable anaesthetic approach for orthopaedic surgery in patients with severe aortic stenosis. This case reinforces the role of regional anaesthesia as a safe and effective strategy in high-risk cardiac patients undergoing urgent non-cardiac surgery.