STUDY OBJECTIVE: To determine whether interscalene brachial plexus block (ISB) provides adequate anesthesia for surgery on or about the elbow. STUDY DESIGN: Case series. SETTING: Operating room of an academic teaching hospital. PATIENTS: 78 patients scheduled for elective elbow surgery. INTERVENTIONS: All patients received an ISB using a low approach technique. A stimulating needle was inserted in the interscalene groove two cm above the clavicle. A volume of 35-45 mL of mepivacaine 1.5% or ropivacaine 0.5% was administered after obtaining a motor response of any component of the brachial plexus with a current intensity of 0.2-0.4 mA (0.1 msec). MEASUREMENTS: Block success rate, defined as the ability to complete surgery without use of intraoperative opioids or general anesthesia, was assessed. Verbal rating scores for pain (0 = no pain, 10 = worst pain imaginable) were obtained in the recovery room. MAIN RESULTS: Low ISB resulted in successful surgical anesthesia in 75 (96%) of the study patients. Verbal rating scores were low (0-2) for all patients postoperatively. CONCLUSIONS: The low interscalene block can be used to provide surgical anesthesia in the majority of patients having surgery on or about the elbow.