Digital nerve block

From Ganfyd

Misnomer. A bit each side, not all the way round. No adrenaline!

Synonym for digital nerve block, a useful local anaesthetic technique which should be in every doctor's repertoire.

Before performing the block sensation in the digit should be assessed and recorded, this is essential in trauma.

Clean the skin according to the current fashion, and insert a fine needle from the dorsal aspect into the finger beside the web, or the corresponding level in the thumb and little finger edges. The other reason for injecting more proximally at the web area, rather than at the circumference of the digit itself, is that large volumes of anaesthetic can have a tamponade effect and can compress the blood vessels.

The main digital nerves run well anterior on the side of the finger, and are accompanied by the usual artery and vein(s) and none of these should be injected, or ideally, even punctured.

Solutions containing adrenaline should not be used for fear of inducing digital ischaemia.

Lidocaine in 1% or 2% concentration is quickly effective and adequate for many procedures, such as incising a paronychia, but prilocaine or bupivacaine will give longer or considerably longer effect. Lidocaine is usually best. A total volume of 5ml is at least sufficient, and 2ml often is.