Introduction: Patient with upper limb fracture with ipsilateral limb AV fistula, anaesthetic options are still challenging. Case Report: A 40 year old male patient who is an K/C/O CKD on maintenance hemodialysis and hypertensive on medication.Patient had AV fistula on the same side of the fracture, Detailed examination of the fistula was done, 1. Thrill over the fistula palpated. 2. Bruit was auscultated on the fistula side. 3. Radial pulse was palpated for volume and rhythm. 4. Fistula hand was compared with other hand for colour , any cyanosis or pallor, temperature, ulcer, edema , pigmentation or peeling of the skin and Nicoladoni Branham sign was negative Under USG, plexus was identified. Using 23G spinal needle , Bupivacaine 0.5(H) 15ml[75mg] plexus . Post supraclavicular block , both sensory and motor blockade was checked. Without tourniquet surgery was proceeded , face mask with 5L/min of O2 was given to the patient. Intraoperatively patient was hemodynamically stable, maintenance fluid of 0.5ml/kg/hr. Post procedure examination of AV fistula was repeated to check the patency. Conclusion: Use of regional anaesthesia over general anaesthesia in distal end fracture with ipsilateral AV fistula has advantage in both in management and patency of the AV fistula.