Aim of the study is to determine the best cut off value for the PI and PI ratio for predication of successful supraclavicular brachial plexus block in young and middle age patients undergoing hand surgeries .

• The supraclavicular nerve block was performed under guidance of a linear transducer (8-14 MHz; Acuson x300; Siemens Healthcare, Seoul, Korea) over the supraclavicular fossa in the coronal oblique plane immediately superior to the midclavicular point. The block was induced in the semi-sitting position, with the head of the patient turned away from the side to be blocked.
• The PI was measured using Masimo SET pulse oximeter, applied on the index finger. The PI was recorded at baseline and at 10, 20, and 30min after local anaesthetic injection in both the blocked limb and the contralateral unblocked limb using two separate oximeters.
• The PI ratio was calculated as the ratio between the PI at 10min after injection and the baseline PI. In every patient, a comparison between the blocked and unblocked limb was performed.
• PI was recorded at baseline and at 10, 20, and 30 min after local anaesthetic injection in both the blocked limb and the contralateral unblocked limb.
• PI ratio was calculated as the ratio between the PI at 10 min after injection and the baseline PI.
• Vital data (Blood pressure, Heart rate, SPO2) was recorded before giving the block and at 10, 20, and 30 min after local anaesthetic injection and at the end of the operation.

Inclusion Criteria:

• Adult patients aging between 15_ 60 years of both sexes.
• Patients undergoing Elective hand Surgeries under successful supraclavicular brachial plexus block anesthesia.
• American Society of Anesthesiologists (ASA) physical status classes I - II.

Exclusion Criteria:

• Patient's refusal of procedure or participation in the study.
• ASA classes III or above.
• Coagulopathy and bleeding disorders.
• Contraindications to supraclavicular brachial plexus block anesthesia such as local infection.
• Hypersensitivity to the study medications.
• Diabetes mellitus.
• Peripheral vascular disease.
• Emergency surgeries.

All patients undergoing elective hand surgeries at El-demerdash Hospital of Surgery during the study period.