Objective： To explore the efficacy and safety of the anesthesia management scheme that on the basis of Ultrasound- guided supraclavicular brachial plexus block in critical elderly patients with upper limbs fracture surgery. Methods: Thirty-two American Society of Anesthesiologists (ASA) class, Ⅲ or Ⅳ patients scheduled for elective upper limb fracture operation under ?supraclavicular brachial plexus block?, age over 60 years old,Body mass index(BMI) 18.6～24.9 kg·m－2. Each 16 cases of men and women, were divided into two groups according to the age. A group of 60-74 years old, B group of more than 75 - year – old. Portable ultrasound device scan brachial plexus in the supraclavicular fossa, adjusting the Angle of the needle and depth under the guidance of ultrasound images. Ropivacaine Dexmedetomidine local anesthetics 25-30 ml injected around the nerves by three times. Then, supplemented by appropriate sedation, analgesia, vascular active drug to maintenance important viscera function. Results: All patients were completed anesthesia according to the established plan, and didn’t carry out general anesthesia because of the inefficiency of anesthesia. During operation, sedation score、cooperation score、anaesthesia effect is satisfactory， Obvious postoperative complications were not observed after 12 hours. Conclusion: On the basis of the anesthesia management plan of ultrasound-guided supraclavicular brachial plexus block in critically ill elderly patients with upper limbs fracture surgery, not only can meet the needs of the intraoperative surgical, and can effectively prevent the occurrence of postoperative complications.