A paratracheal anterior technique of brachial plexus block was performed by using 20 mL of 1.5% mepivacaine on 51 patients undergoing elective surgeries on their upper extremities. Time to onset and level of analgesia were measured, and the efficacy of this technique was evaluated. Success rate was 89%, with none of the patients requiring general anesthesia. Analgesia from C4 to T1 dermatomes was achieved in 52% of the patients within the first 15 minutes and 82% in the postoperative period. Complications associated with this technique were minimal. Although 2 patients complained of dyspnea, oxygen saturation by pulse oximeter was maintained within the normal range. Symptoms of clinical toxicity of the local anesthetics and/or tourniquet pain were not observed in any patients. We concluded that brachial plexus block by the paratracheal anterior approach can be effectively applied to produce anesthesia during upper extremity surgery with an excellent success rate and minimal complications. Copyright © 2000 by W.B. Saunders Company