Nutcracker syndrome (NCS) is a rare vascular disorder caused by compression of the left renal vein, and pregnancy may aggravate its clinical manifestations. We report the anesthetic management of a 37-year-old primigravida with pre-existing NCS who underwent elective cesarean delivery at term. Spinal anesthesia was performed with continuous arterial pressure monitoring and preparation for potential bleeding. Transient hypotension following spinal anesthesia was promptly treated with a vasopressor, and the subsequent perioperative course was uneventful. This case suggests that spinal anesthesia may be a feasible option for cesarean delivery in parturients with stable NCS when accompanied by careful hemodynamic management and appropriate preparation for potential complications.