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Abstract Upper limb surgeries are mostly performed under regional blocks; regional blocks not only provide intraoperative anesthesia but also provide a postoperative analgesia that extends for hours without any systemic side effects. Regional anesthesia such as a brachial plexus block (BPB) involves injection of local anesthetic (LA) around nerves to block the sensory and motor nerves that supply the operative site. Supraclavicular approach is one of the different approaches of brachial plexus block by different local anesthetics. The blind approach which rely on surface landmarks before needle insertion and elicitation of paresthesia or nerve-stimulated muscle contraction after needle insertion with multiple trial and error needle attempts result in procedure related pain and more risk of complications as pneumothorax. Ultrasound guidance has many advantages, as it can potentially improve the success rate up to 99%, fastens the onset time and reduce the risk of complications. Many studies demonstrated the effects of cooling of the local anesthetics increase its density and viscosity, thus limit the intrathecal spread of bupivacaine, therefore increase the success rate of the block and improve its onset. Cooling also decreases the amplitude and increases the duration and the latency of the compound action potential. |