Ropivacaine is a long-acting regional anesthetic that is structurally related to bupivacaine. It is a S(−) enantiomer, unlike bupivacaine, which is a racemate and  well-established long-acting regional anesthetic, which like all amide anesthetics has been associated with cardiotoxicity when used in high concentration or when accidentally administered intravascularly. Hence ropivacaine was developed for the purpose of reducing potential toxicity and improving relative sensory and motor block profiles. Various adjuvants have been added to local anesthetics in brachial plexus block to achieve quick, dense, and prolonged block; however, the results are either inconclusive or associated with side effects.

Nalbuphine, a derivative of 14-hydroxymorphine, is an agonist-antagonist opioid acting on µ (mu) receptors as antagonist and κ (kappa) receptors as agonist with an analgesic potency equal to morphine and its antagonistic potency is approximately ¼th of that of naloxone. Unlike morphine, it exhibits a ceiling effect on respiratory depression. Nalbuphine has the potential to maintain or even enhance µ-opioid-based analgesia while simultaneously mitigating the µ-opioid side effects. Therefore the purpose of this study is to compare by adding nalbuphine with ropivacaine in supraclavicular brachial plexus block and to know its efficacy.