Seventy reconstfuctive operations on the hand were done with the patient's full co-operation during the procedure. Anaesthesia was provided by a peripheral nerve block at the level of the wrist or the metacarpo-phalangeal joint. This technique enabled the surgeon to estimate the required extent of such operations as tenolysis, arthrolysis, arthroplasty, and tendon graft. It also helped the patient to appreciate the movement he could achieve post-operatively.