الفهرس 
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Abstract
This study aimed to : Brachial plexus block is indicated for upper extremity surgery and many techniques are available. The key to success depends on the accuracy of needle placement, nerve localization, and local anesthetic injection. Current techniques of nerve localization rely on surface anatomic landmarks for estimating brachial plexus location. However, at the time of needle insertion, the search for target nerves remains “blind”; thus, nerve localization can be frustrating and time consuming. Most often, block failures result from imprecise needle placement, and even in experienced hands, the failure rate can be as high as 10–15 %. Blind techniques can also cause complications, patient discomfort, and long procedure times. Although infrequent, direct or indirect needle injury may cause serious complications such as nerve damage , spinal cord injury, pneumothorax, vascular puncture and systemic local anesthetic toxic reactions. Complications aside, the trial-and-error approach to nerve localization often requires multiple needle attempts, leading to patient anxiety and operating room delay. In the supraclavicular area, the brachial plexus is more superficial; its trunks/divisions are close to each other and are easy to visualize. Hence, we speculated that using a higher frequency transducer (10 MHz) and injecting a local anaesthetic to obtain full circumferential spread around the nerves will result in a faster and a more effective sensory block of the upper extremity with the supraclavicular approach than the infraclavicular approach. In this prospective study we compared ultrasound guided and nerve stimulator guided supraclavicular block as regard the block performance times, the spread of sensory block, the intensity and duration of motor block, the safety of both approaches (incidence of adverse events and complications), and the results obtained in other studies. The patients of this study were randomly allocated into two equal groups (40 patients each) according to the used method of nerve localization. In the current study we concluded that the use of ultrasound guided brachial plexus block, appears to permit accurate deposition of the local anesthetic perineurally and to be associated with a high success rate, short onset time, easy placement of needle, low complication rate, and excellent analgesia and that the conventional techniques for brachial plexus blocks using anatomic landmarks or even nerve stimulation guidance are blind in nature and can result in unpredictable block failure, inadvertent puncture of adjacent structures leading to complications, or frustrating and time consuming trial, and error attempts.