Background There are few case reports in which non-cardiac surgery under regional anesthesia has been described in a patient with a pulmonary artery aneurysm. We report a case in which we managed a 74-year-old lady with a hip fracture for fixation under spinal anesthesia after thorough evaluation and meticulous planning. The patient was discharged home after 5 days without any perioperative events. Case presentation A 74-year-old, hypertensive lady with an incidentally detected pulmonary artery aneurysm was posted for a dynamic hip screw. Two-dimensional echocardiography revealed normal biventricular function with an ejection fraction of 60%, no regional wall motion abnormalities, concentric right ventricular hypertrophy (tricuspid annular plane systolic excursion or TAPSE of 19 mm), severe calcific pulmonary stenosis (PS) with pressures 90/61 mm Hg, pulmonary valve annulus of 12 mm, and pulmonary artery systolic pressure of 35 mm Hg. The left and right pulmonary artery diameters were 17 mm and 20 mm, respectively. She was clinically asymptomatic with an oxygen saturation of 98% on room air. A sequential lumbar epidural anesthesia was planned for this patient given her age, overall frail condition, and to avoid airway instrumentation. As epidural was difficult due to fused spaces, a sub-arachnoid block was administered with continuous monitoring. Surgery was uneventful and the patient was discharged on the 5th postoperative day. Conclusions With this case report, we suggest that a central neuraxial blockade could be administered in presence of severe PS with meticulous monitoring and careful planning.