Regional blocks have secured a pivotal role in modern anaesthetic practice with their ability to achieve ideal operative conditions without much of systemic side effects. They offer an excellent alternative for patients who are hemodynamically compromised or too ill to tolerate general anaesthesia . For the majority of upper limb surgeries carried out on a daily basis, supraclavicular brachial plexus blockade is the technique of choice due to its effectiveness in terms of success rates, margin of safety, and efficient postoperative analgesia .

                  The first supraclavicular brachial plexus block was performed by Kulenkampff D in 1912 .Though relatively new, ultrasonographic visualization of the targeted nerves shows promise for the future. This makes it possible to see the block needle, the distribution of local anesthetic, and peripheral nerves directly. Past few years have observed a great increase in the use of ultrasound for regional nerve blocks.

                 An ideal drug should have a fast sensory onset, differential offset, with an earlier offset of motor than sensory blockade, enabling early ambulation or movements with prolonged analgesia. Several combinations of LAs and adjuvants such as tramadol,  sufentanil,  clonidine and fentanyl have been employed in the search for near ideal agent, which has proven to be unattainable

               Currently, levobupivacaine ie S enantiomer of bupivacaine with favorable clinical profile and lesser cardiotoxicity when compared with racemic bupivacaine is being favoured LA for regional block.

              Dexmedetomidine, a pharmacologically active dextro-isomer of medetomidine, is a selective alpha 2 adrenoceptor agonist employed for use as an adjuvant during regional anaesthesia.It inhibits the neuronal conduction by blocking hyperpolarization activated cation currents and produces analgesia.           

               Dexmedetomidine has been added perineurally at various doses; however, the optimal dose is still unknown. Analgesia lasts longer at higher doses of dexmedetomidine, such as 1to 2 mcg per kg, but at the expense of more adverse effects, such as bradycardia and hypotension.There are very few studies which evaluated the efficacy of low dose ie 30mcg of dexmedetomidine as an adjuvant to local anaesthetic to prolong the block characteristics.

             Clonidine had been used as an adjunct to local anaesthetic agents in various regional techniques to extend the duration of block. It is a centrally acting alpha-2 adrenergic agonist. It has been added perineurally at various doses; however, the optimal dose is still unknown. Analgesia lasts longer at higher doses of clonidine.