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the patient is lying in supine position the forearm in supination with the hand dorsam lying on the table trace the wrist flexor crease then draw a line along the flex sari Alaris tendon the puncture site is located 3 cm proximal to the wrist flexor crease immediately post ior to the flex sari Alaris tendon after skin disinfection the nerve stimulator is set above 1 milliamp and fitted with a 50 mm insulated needle introduce the needle perpendicularly to the skin until elicited motor response thumb adduction and flexion of the fourth and fifth fingers find the optimum needle location lowering the current to 2.5 milliamps after careful aspiration a 1ml test dose will stop the motor response and 5 ml of local anesthetic can then be injected