Pacemakers are the devices which will produce automaticity of the heart by initiating electrical mechanical activity. Type of the pacemaker, type of pacing, manufacturer address, battery life, any malfunctioning of the device should be known by anaesthesiologist well before starting of the case. This knowledge help us to avoid complications and to choose which type of anaesthesia for that particular surgery. Its better to know always what all things we are using inside the operation theatre which interferes with the electrical mechanical activity and how to avoid them. Choosing of anaesthesia technique is very important for the safety of the patient, as there are many complications like arrythmias, malfunctiong of the device, hypotension, cardiac arrest can occur. We should be aware of these complications and should take precautions to reduce complications. we are thus concluding nerve blocks can also be safest anaesthesia techniques for many surgeries with patients having permanent pacemakers. Regional anaesthesia techniques are very much safe in these type of cases. Nerve blocks are safest because of their least interference with haemodynamics.