This research study is to determine if the insertion site of a perineural catheter or tiny tube placed next to the nerves that go to the part of the body (hand or arm) having surgery, affects the amount of pain relief that is experienced after surgery. Catheters will be placed in either the supraclavicular or infraclavicular location.

To determine if a particular perineural local anesthetic catheter location (supraclavicular or infraclavicular) will maximize postoperative analgesia, minimize oral opioid requirements, minimize sleep disturbances resulting from postoperative pain, and maximize patient satisfaction.

Inclusion Criteria:

• 18 years of age or older
• unilateral, upper (at or distal to the elbow) extremity orthopedic surgery with moderate-to-severe postoperative pain expected
• patients already agree to and want a continuous brachial plexus block for postoperative analgesia

Exclusion Criteria:

• patients who have difficulty understanding the study protocol or caring for the infusion pump/catheter system
• patients who have any known contraindication to study medications
• insulin-dependent diabetes mellitus
• neuropathy of any etiology in the affected extremity
• contraindication to regional blockade (e.g. clotting deficiency)
• any known acute or chronic hepatic or renal insufficiency or failure
• any incision site outside of the catheter-effected area
• chronic opioid use
• history of opioid abuse
• obesity
• pregnancy
• incarceration
• inability to communicate with the investigators and hospital staff