Thanks to Dr. Basile for today’s Morning Report!
New Approach to the Digital Block
Traditional digital nerve block:
– two injections where you hit all four digital nerves with injections on both sides of the finger at MCP joint
– Does not work at least 10% of the time
Single injection volar approach:
– Single injection
– Less amount of anesthetic used
– Subcutaneous injection to volar aspect of proximal digit or at proximal skin crease
Article described in EMRAP:
Cannon B et al. Digital anaesthesia: one injection or two? Emerg Med J. 2010 Jul;27(7):533-6
– 2-3 cc anesthetic into flexor tendon at proximal crease on volar aspect of digit and massage into the tendon sheath
– Do not go all the way to the bone
– Randomized-controlled trial
– Blinded physician to type of block (traditional vs single injection subcutaneous)
– Outcomes were good anesthesia at 5 and 10 minutes as well as patient satisfaction and self-reported distress
– 76% of patients in the single injection group were adequately anesthetized at 5 min vs 65% in traditional technique
– 89% in the single injection group at 10 min compared to 82% in the traditional group
– Patient satisfaction scores and self-reported distress were better in the single injection group
Tzeng YS, Chen SG. Tumescent technique in digits: a subcutaneous single-injection digital block. Am J Emerg Med. 2012 May; 30 (4): 592-6.
– Prospective study of subcutaneous single-injection digital block of 3-3.5 ml anesthetic into volar aspect of proximal digit
– Volume sufficient to moderately distend the skin on volar and dorsal aspects of proximal digit
– Effectiveness was determined 5 min after injection
– Successful in all digits (113 fingers and 10 thumbs)
– No adverse events noted at 48 hour and one month follow up
Single injection digit block: Easier, quicker…. PRACTICE CHANGING??????
References:
1) Arora S, Menchine M. Paper chase 4- digital anesthesia. EMRAP Dec 2013. https://www.emrap.org/episode/2013/december/paperchase4
2) Cannon B et al. Digital anaesthesia: one injection or two? Emerg Med J. 2010 Jul;27(7):533-6
3) Tzeng YS, Chen SG. Tumescent technique in digits: a subcutaneous single-injection digital block. Am J Emerg Med. 2012 May; 30 (4): 592-6
Jay Khadpe MD
Latest posts by Jay Khadpe MD (see all)
- Morning Report: 7/30/2015 - July 30, 2015
- Morning Report: 7/28/2015 - July 28, 2015
- IN THE STRETCHER INSTEAD OF BESIDE IT - July 22, 2015
- Morning Report: 7/14/2015 - July 14, 2015
- Morning Report: 7/10/2015 - July 10, 2015