Background: Finger injuries are very common and the majority can be treated under digital block anesthesia. Traditional digital block is one of the most commonly blocks performed by care providers in several medical fields. There is another less known method, Transthecal (Pulley) block, in which local anesthesia is injected into the flexor tendon sheat. This manuscript compares the effectivenss of these two techniques.Methods: A prospective randomized clinical trial was performed comparing Transthecal pulley block with digital block anesthesia in terms of length of achieved anesthesia and possible need for supplemental anesthesia. 100 consecutive patients who required surgery for their finger injuries randomly received Traditional digital block or Transthecal pulley block. The achieved finger anesthesia was assessed in terms of time and need for additional medication.Results: The mean achieved anesthesia was 34.2 minutes in Transthecal and 33.8 minutes in digital blocks. A repeat infiltration of local anesthesia became necessary in 5 instances in the Traditional digital block and none in Transthecal technique.Conclusions: Because of fewer needs for repeat local anesthetic injection, and lesser risk of neurovascular bundle damage, Transthecal block is suggested as a more suitable local block for finger surgery.