Introduction: Ischemic priapism is a urological emergency characterized by a painful and prolonged erection secondary to venous outflow obstruction of the corpora cavernosa. Timely treatment is essential to prevent irreversible tissue damage and permanent erectile dysfunction. Evidence regarding optimal anesthetic management in urgent penile surgery remains limited. Objective: To describe the anesthetic approach using subarachnoid block with titrated sedation in a patient with refractory ischemic priapism, as well as the perioperative course. Clinical case: A 45-year-old male patient, without chronic diseases, presented with ischemic priapism of 24 hours’ duration. Due to lack of response to conservative measures, glansectomy with exploration of the corpora cavernosa was performed under subarachnoid block with hyperbaric bupivacaine and dexmedetomidine as an adjuvant, in addition to intravenous sedation. The procedure was completed with hemodynamic stability, adequate analgesic control, no intraoperative complications, and rapid recovery. The postoperative course was favorable, without adverse events, with partial preservation of erectile function. Discussion: The clinical evolution is consistent with evidence supporting the use of regional anesthetic techniques in penile surgery, which offer advantages such as effective analgesia, reduced need for general anesthesia, and faster recovery. The use of intrathecal dexmedetomidine contributed to deeper analgesia and cardiovascular stability. Early intervention was key to limiting cavernous tissue damage. Conclusion: Subarachnoid block with titrated sedation represents a safe and effective anesthetic alternative in emergency surgeries for ischemic priapism, promoting hemodynamic stability, optimal analgesia, and accelerated recovery. This case provides relevant evidence on the value of regional techniques in urgent urological procedures and underscores the importance of a multidisciplinary approach to optimize functional outcomes.