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Abstract
Peripheral nerve block may be used for surgical anaesthesia alone or, in conjunction with general anaesthesia and for the acute and chronic pain management.Brachial plexus block is an easy and relatively safe procedure for upper limb surgeries, though there are different approaches to it, out of which supraclavicular approach is most consistent and widely used method for anaesthesia and perioperative pain management in surgery below shoulder joint.Various local anaesthetic agents are used in brachial plexus block but most commonly used drugs are; bupivacaine, and lidocaine. Bupivacaine is long acting whereas lidocaine is short acting drug.Adding novel adjuvants to brachial plexus block prolongs the analgesic effect and also allows reduction in the total dose of local anaesthetic used. Novel adjuvants studied to date include: opioids, clonidine, neostigmine, tramadol, midazolam, dexmeditomidine etc.Neostigmine is a parasympathomimetic agent, specifically, a reversible cholinesterase inhibitor. By interfering with the breakdown of acetylcholine, neostigmine indirectly stimulates both nicotinic and muscarinic receptors .