Regional anesthesia for upper limp with peripheral nerve blocks (PNB) can provide superior analgesia and a lower incidence of side effects compared to parenteral anesthetics. The key step is identifying the anatomy of brachial plexus that is formed from anterior primary ramie from C5 to T1 that ES and US helping in doing it. ES (Electric Stimulator) based on technique that relies on physiological responses of neural structures to ES, for which there is inter-individual variation so alone ES has it is limitation. Ultrasound has proved helpful for regional anesthesia in two ways it allows the systematic, noninvasive, in vivo assessment of topographic sonography and its variations and provides guidance and direct visualization of needle entrance, so in combination with ES the accuracy becomes higher.