The purpose of this study is to compare two different injection sites for local anesthesia in patients having hand surgery. The hypothesis is that subjects receiving injections around the three nerves of the forearm will provide faster pain control and greater patient satisfaction than patients having one injection closer to the shoulder.

Inclusion Criteria:

• Patients ≥ 18 years of age undergoing unilateral hand, wrist, or finger surgery
• Ability to understand and provide informed consent
• American Society of Anesthesiologists (ASA) status I-III

Exclusion Criteria:

• Patient refusal or inability to provide informed consent
• True allergy, not sensitivity, to any of the following substances: Local Anesthetics, Midazolam, Fentanyl, Hydromorphone, Propofol
• Pregnancy
• Severe hepatic impairment
• Evidence of infection at or near the proposed needle insertion site
• Any sensorimotor deficit of the ipsilateral upper extremity, whether acute or chronic, as determined by the PI and designee
• Pulmonary disease of any kind that is uncontrolled or severe in nature
• Chronic pain patients, defined as someone diagnosed with chronic pain or a chronic pain condition, under the care of a chronic pain physician, or taking oral/intravenous narcotics consistently for 30 days prior to surgery