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Abstract
Pain is an everyday challenge during all surgeries. And it is a chief postoperative complication, so pain management is a corner stone in anesthetic practice. Regional anesthesia and especially peripheral nerve block is sometimes employed as an alternative or as an adjunct to general anesthesia for surgery of the upper extremity avoiding the undesired effect of anesthetic drugs used during general anesthesia and the stress of laryngoscopy and tracheal intubation. Patients can also enjoy postoperative period free from nausea, vomiting, cerebral depression and immediate postoperative pain . Opioids can be added to local anesthetics to prolong the block duration and reduce the toxicity