Inclusion Criteria:  American Society of Anaesthesiologists (ASA) physical status I-III undergoing elective or emergency upper extremity surgery involving the proximal humerus to distal hand or surgery involving any combination of these regions scheduled for a brachial plexus block  Exclusion Criteria:  Patient refusal Pregnancy Skin infection at the site of block History of allergy to local anesthetic agents Bleeding tendency or with evidence of coagulopathy Pre-existing neurological deficit or neuromuscular disease