<![CDATA[Background: Non-obstetric surgery during pregnancy requires an anesthetic strategy that preserves maternal safety while minimizing fetal risk. Regional anesthesia is an attractive option for upper-extremity surgery because it avoids airway manipulation and reduces systemic drug exposure. We describe the use of ultrasound-guided axillary block for distal radius fracture surgery during second-trimester pregnancy.Case: A 33-year-old woman (gravida 2, para 1, living 1) at 18–19 weeks’ gestation, American Society of Anesthesiologists physical status II, presented with a closed distal-third right radius fracture requiring open reduction and internal fixation. Obstetric assessment and fetal heart rate were normal. Mild sedation was achieved with intravenous midazolam 1 mg and fentanyl 50 µg, with supplemental oxygen and continuous respiratory monitoring. Ultrasound-guided axillary block was performed using 10 mL 0.5% levobupivacaine, 6 mL 2% lidocaine, and dexamethasone 5 mg; total local anesthetic doses remained within accepted safety limits. Complete sensory and motor block developed within 15 minutes. The 1-hour procedure was completed uneventfully without conversion to general anesthesia, with stable maternal hemodynamics and normal fetal heart rate throughout. Postoperative analgesia was satisfactory, requiring one fentanyl patient-controlled analgesia activation. She was discharged on postoperative day 2. At 37 weeks, elective cesarean delivery resulted in a healthy mother and neonate, with no obstetric complications.Conclusion: Ultrasound-guided axillary block provided effective surgical anesthesia and prolonged postoperative analgesia for distal radius fracture surgery in this second-trimester pregnant patient, with favorable maternal and fetal outcomes. pregnancy, non-obstetric surgery, axillary block, brachial plexus block, distal radius fracture, regional anesthesia.]]>
