Abstract Background Intravenous regional anesthesia (Bier block) and monitored anesthesia care (MAC) with local anesthesia injection are routinely used for minor hand procedures. This study evaluates differences in post-operative pain control, PACU medication consumption, and duration of patient care. Methods Patients between 18 and 89 years of age who had trigger finger or carpal tunnel release performed were evaluated over a one year period. Demographics, pain score on arrival to PACU, highest Visual Analog Score (VAS), and pain score at discharge were evaluated alongside surgery, anesthesia, and tourniquet times. Results The average age was 58.8 and was significantly different between Bier and Local/MAC groups (P = 0.0217). There were 106 carpal tunnel releases and 34 trigger finger releases. Median time in surgery was 18 min for the Bier group and 15 min for the MAC group and statistically different (p = 0.0095). Median tourniquet time was 24.5 min for the Bier group and 14 min for the MAC group which was statistically significant (p = 0.0001). Median immediate post-operative pain score was significantly different between Bier and MAC groups (0 IQR:2 vs. 0 IQR:0), p = 0.0076). Discharge pain score was significantly higher for Bier block group than MAC group (0 IQR:3 vs. 0 IQR:0, p = 0.0001). Postoperative pain presence was less likely with Local MAC than Bier block (OR 0.197, 95%CI: 0.067, 0.578). Conclusion The likelihood of a zero pain score was greater in the Local/MAC group than the Bier block group. Tourniquet times did not affect pain scores in either group. Surgical procedures and anesthesia care times were shorter in the Local/MAC group.