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Digital Nerve Block (Emergency Medicine)

  • Editor(s): Todd W Thomsen, MD, Gary S Setnik, MD, FACEP
  • Section Editor(s): Phillip M Harter, MD
  • Contributor(s): Carmie Chan, MD
PRE-PROCEDURE
INDICATIONS

Digital nerve blocks are useful for achieving quick and effective anesthesia in fingers or toes, with minimal invasiveness and anesthetic requirements. As such, digital nerve blocks are indicated for a wide variety of procedures requiring digital anesthesia.
CONTRAINDICATIONS
  • There are no relative or absolute contraindications to digital nerve block.
  • Risks of using epinephrine-containing anesthetics are likely to be greater in persons with known or suspected circulatory compromise, such as peripheral vascular disease, and vascular or crush injuries.
EQUIPMENT
  • Gloves, eye protection, and other personal protective equipment. **UNIVERSAL PRECAUTIONS**
  • Antiseptic solution (chlorhexidine or povidone-iodine) to clean the skin **STERILE TECHNIQUE**
  • 10-mL syringe
  • One 18-gauge and one 25- or 27-gauge, 1-inch needle
  • Anesthetic
  • For most digital nerve blocks, either 1% lidocaine or 0.25% bupivacaine can be used.
ANATOMY
  • There are two dorsal digital nerves at the 10 and 2 o’clock positions of the phalanx, and the palmar digital nerves are at the 4 and 8 o’clock positions.
  • The dorsal digital nerves are branches of the radial and ulnar nerves.
  • The palmar digital nerves are branches of the median and ulnar nerves. Each palmar digital nerve is closely associated with a digital artery and vein.
Digital nerve block.
Figure 1 :  Digital nerve block.

Equipment.
Figure 3 :  Equipment.

Dorsal digital nerves.
Figure 4 :  Dorsal digital nerves.

Volar digital nerves.
Figure 5 :  Volar digital nerves.


PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
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First, anesthetize the dorsal nerve.
Figure 9 :  First, anesthetize the dorsal nerve.

Next, anesthetize the volar nerve.
Figure 10 :  Next, anesthetize the volar nerve.

Inject anesthetic over the metacarpal head.
Figure 13 :  Inject anesthetic over the metacarpal head.


POST-PROCEDURE
CARE

Reassess and document the neurovascular status of the digit.
COMPLICATIONS
  • Neurovascular injury
  • Ischemia
  • Should digital ischemia complications develop and not resolve spontaneously within 15 minutes, several strategies can be used to restore perfusion.
    • Massage of the affected area and application of topical nitroglycerine paste may help to restore perfusion.
    • 2 mg of phentolamine can be injected locally to reverse the vasoconstriction.
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