Ultrasound-guided (USG) injections have gained popularity during the performance of various nerve blocks, including the cervical sympathetic blockade. USG visualization of needles, nerves, blood vessels, and soft tissues may help prevent inadvertent tissue trauma and intravascular and intraneural injections, allow visualization of the medication spread, and reduce the local anesthetic dose required to achieve reliable blockade. In this chapter, we will review the available literature and different approaches to USG cervical sympathetic blocks while discussing the advantages and disadvantages of each technique.