Arm Elevation for Prevention of Propofol Injection Pain

Inclusion Criteria: * ASA I-III * 18G or 20G dorsal hand working IV in place (drip by gravity) * Planned IV propofol infusion with natural airway * Able to provide consent * Able to report pain * English-speaking Exclusion Criteria: * Allergy to propofol/lidocaine * Significant cognitive impairment/acute psychosis * Any sedative medications given prior to the study * Pregnancy * Severe upper-extremity mobility limitation that prevents safe arm elevation * Emergency medical condition; (e.g. GI bleeding, sepsis, acute heart or respiratory failure) * Chronic pain syndrome with chronic opioid use * Any acute pain condition that may be distracting to the patient * Any report of pain on gravity drip, injection of saline or spontaneous pain when testing the iv in preop prior to bringing the patient to the OR * Pathology or prior surgery that is deemed to interfere with normal venous drainage of the arm (arterio-venous fistula, history of port or dialysis line, , history of heart failure) * History of past or current cardiac arrhythmias, cardiac valvular abnormalities, /heart failure, stable angina that are expected to require concomitant administration of vasoactive or inotropic medications with induction * TIA or stroke within the last 3 months