• Thrivikrama Padur Tantry, Reshma Koteshwar, Harish Karanth, Pramal Shetty, Vasanth Shetty, and B G Muralishankar.
• Department of Anaesthesiology, A J Institute of Medical Sciences, Kuntikana, Mangalore, India.
• Anesth Essays Res. 2015 May 1; 9 (2): 225-9.

BackgroundThe sparing of ulnar nerve often leads to the failure of the upper limb blockade. It has been claimed that local anesthetic injection at the site of stimulator evoked finger flexion response is associated with highest success rate of a successful block. The lower trunk stimulation of plexus should yield similar results as this trunk contributes significantly for median and ulnar nerves of hand and forearm.Materials And MethodsThe patients with intact anatomical upper limb structures underwent (a) combined ultrasound (USG) assisted nerve stimulator evoked motor response evaluation or in (b) open brachial plexus trunk stimulation evaluations. The individual patient's lower trunk stimulation motor responses were documented.ResultsWhen combined the results of both USG and open plexus groups, wrist flexion was seen in 52%, finger flexion in 61% and forearm pronation or twitches of anterior compartment in 48% of total subjects studied. These responses were noted either separately or in combinations.ConclusionWe conclude other than finger flexion, the wrist flexion the forearm twitches, pronation and wrist adduction may be used for lower trunk blockade and thus for higher accuracy.

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