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Objective: To assess the reliability and safety of ultrasound guided medial cervical plexus blockade. Design: Prospective observational study. Setting: Department of Anesthesiology and Critical Care, Regional Tertiary Hospital. Materials and methods: We studied 50 ASA II-III patients (28 males and 22 females, average age 62 years) undergoing carotid endarterectomy. Medial cervical plexus blockade was performed under ultrasound guidance using „in plane" technique. We injected 20 mL of 0.375% bupivacaine in between the fasciae dividing the sternocleidomastoid and levator scapulae muscles. All patients received 100 mcg of intravenous fentanyl after block administration. We documented the incidence of satisfactory blockade for carotid artery surgery, the need for supplementary infiltrative local anaesthesia with 1% trimecaine, the need for conversion to general anaesthesia and the complication rate. Results: Medial cervical block without any supplementary local anaesthesia was achieved in 32 (64%) patients. Supplementary infiltration of local anaesthetic into the operative area was required in 17 (34%) patients. Only one patient required repeated local anaesthetic supplementation. Conclusion: Conversion to general anaesthesia was not necessary in any of our patients. The following complications were encountered: transient unilateral recurrent nerve block in two patients and transient phrenic nerve block in one case. [ABSTRACT FROM AUTHOR]