and patients with increased anesthetic risk can be treated safely. No local anesthetic is present at the incision site; this allows a more anatomic dissection without distorted tissues. The patient maintains use of the fingers and hand and can be released promptly from the day surgery area. The effects of the anesthetic last 6 to 8 hours, providing postoperative pain relief. A tourniquet can be placed on the distal forearm for the short time required for performance of the procedure. If desired, the tourniquet may be deflated without loss of anesthesia. The anesthetic can be administered in a preoperating room to expedite turnover time between operations. The potential for variation in nerve distribution to the palm must be remembered.’ This is the reason the anesthetic agent is placed above the fascia, allowing for more proximal branching of the median palmar cutaneous nerve as well as lateral and medial antebrachial cutaneous nerve distributions. The palmar cutaneous branch of the ulnar nerve is also anesthetized with this technique. If, for some reason, the block fails, the local anesthetic agent can still be injected at the incision site, since the amount of anesthetic used is far below the toxic level in adults. The most common area of persistent sensation is the thenar crease; an additional 5 ml of anesthetic may be injected subcutaneously in the palmar wrist crease near the flexor carpi radialis tendon to anesthetize this region. The risk of intravascular injection is remote. Only the ulnar artery is within the injection fields, and only a small amount of anesthetic is injected near the artery. As always, the surgeon who performs the block should be familiar with the pharmacology and side effects of local anesthetics, as well as possible complications and their treatment. This technique has also been used for other hand procedures, including palmar tenolysis, with excellent results.