The purpose of this study is to determine whether ultrasound guidance or nerve stimulation is the best option for placing continuous peripheral nerve block catheters for upper limb surgery.

In a multidisciplinary, observer blinded, prospective, single center, randomized study, success rate of US guided versus neurostimulation guided catheter placement for continuous infraclavicular block in patients scheduled for upper limb surgery will be studied. Block effectiveness, time taken, discharge from recovery, postoperative pain and disability and patient acceptance will be studied in 210 patients.

Inclusion Criteria:

• Age 18-80 yrs
• Weight 40-100 kg
• Either sex
• Height >150 cm
• American Society of Anesthesiologists physical status 1-3
• Scheduled for hand or elbow surgery under regional anesthesia

Exclusion Criteria:

• Inability to give informed consent
• Refusal of treatment randomization
• Language barrier
• Allergy to any medications being used in the study protocol
• Ongoing major medical or psychiatric problems
• Chronic pain or narcotic use/abuse
• Peripheral neuropathy or major neurological problems
• Scarring in area of blockade
• Inability to co-operate with post-operative evaluation
• Major coagulopathy
• Pregnancy and breast feeding
• Patients requiring anesthesia of other surgical sites
• Obese patients (i.e. BMI >40)
• Postoperatively, patients will be excluded if they have had additional operative procedures requiring a change in the usual protocol of care