Vascular puncture and haematoma formation are potential complications of peripheral nerve blocks, particularly in anticoagulated patients. This article reviews the differential diagnosis, risk factors, and management strategies for vascular injury following regional anaesthesia. A case of axillary haematoma with radial nerve weakness highlights the importance of early recognition. Ultrasound guidance, avoidance of transarterial techniques, and careful patient selection help minimize risks. Management includes compression, limb elevation, anticoagulation reversal, and surgical evacuation if necessary. While most haematomas resolve conservatively, expanding haematoma’s causing nerve compression or vascular obstruction require urgent intervention to prevent long-term complications.