Arthrogryposis multiplex congenita (AMC) poses major anesthetic challenges due to severe joint contractures, airway restrictions, and a debated risk of malignant hyperthermia. Despite these complexities, anesthetic reports in adult AMC patients remain extremely limited, leaving perioperative management largely unstandardized. We present the anesthetic approach for a 35-year-old male patient with AMC undergoing open inguinal hernia repair. Given the high risk of airway compromise and joint immobility, we opted for ultrasound-guided ilioinguinal and iliohypogastric nerve blocks with dexmedetomidine sedation, avoiding endotracheal intubation and volatile anesthetics. This case highlights regional anesthesia as a critical alternative to general anesthesia, providing valuable insights into safe, tailored anesthetic strategies for this rare and underreported population.