- 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
- 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
- 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
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.
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Figure 1
:
Supplies for performing digital nerve block. From left to right: tray containing sterile prep solution and packet of 4 x 4 inch sterile gauze, two syringes containing local anesthetic with injection needles, marker (optional), and sterile drapes.
Figure 2
:
Innervation of the hand; palmar digital nerves. From Drake R, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone/Elsevier, 2008, p 417.
Figure 3
:
Innervation of the hand; dorsal digital nerves. From Drake R, Vogl AW, Mitchell AWM, Tibbitts RM, Richardson PE: Gray’s Atlas of Anatomy. Philadelphia, Churchill Livingstone/Elsevier, 2008, p 421.
Figure 4
:
Dorsal digital nerve block.
Figure 5
:
Transthecal nerve block.
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