Nail anesthesia is systematic in nail surgery. It is usually performed by the surgeon, a few minutes ahead of the procedure. Several techniques and substances are available. The rules of anesthesia must be respected for surgery to be comfortable, with the whole operated zone anesthetized. The surgeon has to select appropriate type of anesthesia according to the surgical indication, patient age and comorbidities; the local anesthetic must be chosen; contraindications must be respected; the injection site must be selected; the quantity must be determined; and the patient must be monitored for any complications. All these steps are mandatory, before, during and after nail anesthesia, for nail surgery to be painless and safe.