Digital Nerve Block (Anesthesia)

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SAMPLE EXCERPT
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Editor(s): Lee A. Fleisher, MD, FACC, FAHA Lee A. Fleisher, MD, FACC, FAHA

Robert Dunning Dripps
Professor and Chair
Department of Anesthesiology and Critical Care

Professor of Medicine
University of Pennsylvania School of Medicine
| Robert Gaiser, MD Robert Gaiser, MD

Professor of Anesthesiology and Critical Care
Department of Anesthesiology and Critical Care
University of Pennsylvania School of Medicine

Contributor(s): Moustafa M. Ahmed, MD Moustafa M. Ahmed, MD

Assistant Clinical Professor
Department of Anesthesiology and Critical Care
University of Pennsylvania School of Medicine
Philadelphia Veterans Administration Medical Center
Philadelphia, PA
| Acknowledgements Acknowledgements

VIDEO EDITOR
Jeremy D. Kukafka, MD
Faculty
Department of Anesthesiology and Critical Care
Univ of Pennsylvania School of Medicine
Philadelphia, PA

Infraclavicular Nerve Block: Ultrasound-Guided Technique
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Psoas Compartment Block: Ultrasound-Guided Technique
Supraclavicular Nerve Block: Ultrasound-Guided Technique


MEDICAL WRITER
Gail A. Van Norman, MD
Clinical Associate Professor
Department of Anesthesiology
Univ of Washington
Seattle, WA

MEDICAL AND VIDEO EDITOR AND SUBJECT MATTER EXPERT
Elizabeth J. Watson, MD
Post-Doctoral Fellow
Department of Anesthesiology and Critical Care
Univ of Pennsylvania School of Medicine
Philadelphia, PA

VIDEO COORDINATOR
Liang Xue, BS
Research Assistant
Department of Anesthesiology and Critical Care
Univ of Pennsylvania School of Medicine
Philadelphia, PA

PRE-PROCEDURE
INDICATIONS
  • Anesthesia for outpatient surgery on the fingers
  • Anesthesia in ER for minor procedures
    • Repair of lacerations of finger
    • Nail removal
    • Nail bed repair
    • Paronychia drainage
    • Removal of foreign bodies
  • Anesthesia for closed procedures of the finger, such as reduction of fractures or dislocated interphalangeal joint
CONTRAINDICATIONS
  • Absolute contraindications
    • Patient refusal
    • Drug allergy
    • Infection at the site of injection
  • Relative contraindications
    • Traumatic nerve injury
    • Uncooperative patient
    • Peripheral vascular disease, particularly small vessel disease
    • Raynaud’s phenomenon
EQUIPMENT
  • Appropriate resuscitation equipment, including oxygen, suction, emergency airway equipment, and resuscitation medications
  • Local anesthetic, typically 10 mL
    • 1% to 1.5% lidocaine
    • 1% to 1.5% mepivacaine
    • 0.25% to 0.5% bupivacaine
    • 2% chloroprocaine
  • Sterile gloves and mask
  • Sterile fenestrated drape or sterile towels for draping
  • Sterile prep solution
  • 1- to 1.5-inch, 25-gauge, short-bevel needle
  • 4 x 4 inch sterile gauze pack
ANATOMY

The common digital nerves are derived from the median and ulnar nerves. These divide in the distal palm into the volar digital nerves and supply sensory innervation to the sides of the fingers, palmar aspects of the fingers, fingertips, and nail beds. The palmar digital nerves run on the ventral-lateral aspect of the finger, along with the digital vessels, just lateral to the flexor tendon sheath. Small dorsal digital nerves derived from the radial and ulnar nerves supply the back of the finger to the proximal joint. These dorsal nerves run on the dorsolateral aspect of the finger.


PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Immediately after placing the block:
    • Assess the distribution of nerve block.
    • Assess capillary refill in insensate finger.
  • After surgery
    • Assess the capillary refill in insensate finger.
    • Assess for signs of hematoma.
COMPLICATIONS
  • Infection
  • Hematoma
  • Vascular insufficiency and/or gangrene of the finger
  • Nerve injury
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