Inclusion Criteria:  age greater than or equal to 18 years old patients willing to participate and provide an informed consent elective surgical procedures, without emergency, administration of rocuronium for neuromuscular blockade, and recovery of complete neuromuscular function at the end of the surgery  Exclusion Criteria:  patients with unilateral disorders, such as stroke, carpal tunnel syndrome, broken wrist with nerve damage, Dupuytren contracture, or similar wrist injury patients with systemic neuromuscular diseases such as myasthenia gravis renal insufficiency or renal failure significant liver disease patients having surgery that would involve prepping the arm into the sterile field allergy to rocuronium