Ultrasound guided regional blocks are on the rise, many institutes are training their staff to master this technique of regional anesthesia. Regional anesthesia in case of an emergency surgery or elective surgery can be the best choice. The case described here is an example - patient with a halo fixation device after motor vehicle accident scheduled for surgery of the extremity. The main aim of management of this case is to achieve a safe anesthesia with minimal interference of the cervical fixation. Supraclavicular brachial plexus block is a good choice for surgeries of the arm and hand and use of an ultrasound to guide the block adds to the safety profile of this versatile block. It has been described as "Spinal of the upper limb". Patients with co-morbidities and injuries to the cervical spine are challenging cases to anesthetize, as regional anesthesia is a very attractive option, failure of the regional block will expose the patient to all adverse sequelae, which were being avoided by planning for a regional anesthesia. Ultrasound has revolutionized the way regional anesthesia is practiced and the proper drug can be placed at the right place in the hands of an experienced anesthesiologist and the block will help in avoiding all the complications of endotracheal anesthesia in these cases.