Background Accidental intra-arterial injection can cause severe limb ischemia, often resulting in amputation. We reported a number of cases of acute upper limb ischemia with severe pain and ischemia in vascular surgery department for urgent relief of the pain and ischemia. Either ultrasound-guided stellate ganglion block or thoracic paravertebral block was done to protect upper limb from gangrene and amputation. Purpose The aim of the present study is to compare the effect of ultrasound-guided stellate ganglion block with ultrasound-guided thoracic T2 and T3 paravertebral block in relief of pain and ischemia and also to compare the result of the block and complications. Patients and methods Forty American Society of Anaesthesiologists status I–II adult patients 16–60 years of age with acute upper limb ischemia and severe pain were admitted to Vascular Surgery Department of Zagazig University Hospital. They were randomly divided into two groups: group S (n=20) where ultrasound-guided stellate ganglion block was done, and group TPV (n=20), where ultrasound-guided thoracic paravertebral block was done. Both groups received 10 ml bupivacaine (0.25%)+16mg dexamethasone for relief of the pain and ischemia, and the complications that resulted from the procedure were followed and recorded. Results There was significant decrease in visual analog scale in both groups after the stellate ganglion block and thoracic paravertebral block, with minimal complications with thoracic paravertebral block and relief of pain and ischemia in both groups. Conclusion Thoracic paravertebral block is a good choice in acute upper limb ischemia with rapid relief of the pain and restoration of peripheral perfusion with minimal complications