There is no need for anesthetic blocks.I have injected Botox in the hands over 800 times over a course of 10 years or more. I have taken care of hyperhidrosis patients for over 13 years as of this writing in 2012. Very rarely, patients get weakness of a finger but it seems to go away very quickly - within 2 weeks. Because hand muscles are used very frequently, the effect of Botox in causing muscle paresis (weakness) dissipates quickly. Again, a practitioner with a lot of experience is needed to inject Botox for palmar hyperhidrosis because depth of injection is critical - it is done quickly with 5-8 injections for each syringe until ice is applied in between syringe refills and therefore experience in putting the needle in a proper depth is critical. There is not much time wasted because icing in between syringe refills keeps the skin cold and provides proper anesthetic. There is no need for anesthetic blocks. You can drive home with this technique and return to work the next morning. Read my ebook on the link below. H Karamanoukian MD #RealSelf100 Member