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This prospective, randomized, blinded study tested the hypothesis that ultrasound guidance can shorten the onset time of axillary brachial plexus block as compared with nerve stimulation guidance when using a multiple injection technique.Sixty American Society of Anesthesiology physical status I–III patients receiving axillary brachial plexus block with 20 ml ropivacaine, 0.75%, using a multiple injection technique, were randomly allocated to receive either nerve stimulation (group NS, n = 30), or ultrasound guidance (group US, n = 30) for nerve location. A blinded observer recorded the onset of sensory and motor blocks, the need for general anesthesia (failed block) or greater than 100 μg fentanyl (insufficient block) to complete surgery, procedure-related pain, success rate, and patient satisfaction.The median (range) number of needle passes was 4 (3–8) in group US and 8 (5–13) in group NS (P = 0.002). The onset of sensory block was shorter in group US (14 ± 6 min) than in group NS (18 ± 6 min) (P = 0.01), whereas no differences were observed in onset of motor block (24 ± 8 min in group US and 25 ± 8 min in group NS; P = 0.33) and readiness to surgery (26 ± 8 min in group US and 28 ± 9 min in group NS; P = 0.48). No failed block was reported in either group. Insufficient block was observed in 1 patient (3%) of group US and 2 patients (6%) of group NS (P = 0.61). Procedure-related pain was reported in 6 patients (20%) of group US and 14 patients (48%) of group NS (P = 0.028); patient acceptance was similarly good in the two groups.Multiple injection axillary block with ultrasound guidance provided similar success rates and comparable incidence of complication as compared with nerve stimulation guidance.