Aim of the study: to compare between the efficacy of using forearm intravenous regional anesthesia (IVRA) and upper arm IVRA and investigate the effects of nitroglycerine (NTG) compared to fentanyl when added to lidocaine in IVRA in wrist and hand surgery. Patients and Methods: 100 patients divided into 4 equal groups. Patients had upper arm tourniquet and received lidocaine (3 mg/kg) mixed with fentanyl (1 μg/kg) in Group I and NTG (400 μg) in Group III. Patients had forearm tourniquet and received half dose of the aforementioned drugs in Group II and Group IV. Results: there was a rapid sensory and motor block onset and reduction in postoperative diclofenac requirement in group III and group IV compared to group I and group II. Conclusion: Both forearm and upper arm tourniquets showed comperable results. Nitroglycerin was associated with rapid onset of sensory and motor block, and reduction in postoperative diclofenac requirement.