Digital Nerve Blocks
The dogma against epinephrine use in digital blocks is largely unfounded and outdated - Jessica Bode MD
HWN Suggests
Trick of the trade: Single digital block
The traditional ring block involves two injections at the base of the finger (and a third injection if anesthetizing the thumbs and toes). A recent article adds to the literature on a non-traditional approach to the digital block – the single subcutaneous method.
Where do we inject? Midpoint of the crease where the finger joins the palm, on the volar side.
How deep is the injection? Subcutaneously. The anesthetic will deposit on top of the tendon sheath and infiltrate to where the digital nerves are.
How much volume? About 2-3 cc.
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Nerve Blocks of the Hand and Wrist
Digital Blocks
I use a very generous helping of local anesthetic, sometimes as much as 6-8 cc. My go-to anesthetic of choice is typically 0.5% bupivicaine; I prefer this longer acting anesthetic over lidocaine simply because I often don’t know how long the interval will be between performing the block and performing the procedure in a busy ED.
Digital Blocks of the finger: Is one injection better than two?
Most of us are familiar with the traditional digital nerve block involving two or more injections on the dorsal surface of the metacarpals. The goal of these injections is to anesthetize the dorsal nerves that run along the side of the finger [1]. What is there was a digital block technique that involved only one injection? Spoiler alert: there is, and it is called the transthecal digital block.
The Best Agent For Digital Nerve Blocks
Bupivacaine is a good choice, but limited data suggests that this agent causes more pain with administration than does lidocaine with epinephrine.
Articles of Interest
Digital Nerve Block
This is a brief video detailing how to do regional anesthesia...
Hand Nerve Blocks
Nerve blocks of the median, ulnar, radial, and digital nerves are useful for injuries of the hand including fractures, lacerations, and burns.
More Dogma: Epinephrine in Digital Nerve Blocks
The use of epinephrine in digital nerve blocks has been shown to increase duration of action for the anesthetic, and to allow the avoidance of bupivacaine, thereby decreasing the pain of the injection.
Resources
Block Buddy Pro
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StatPearls
The anesthetic choice should be tailored to the length of the desired analgesia. The most commonly used anesthetics are lidocaine (1.5-2 hours), lidocaine with epinephrine (2-6 hours), bupivacaine (2-4 hours), and mepivacaine (3-5 hours).
