Digital Nerve Block (Internal Medicine)

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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.

  • 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.  
  • 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, see Local Anesthesia for further details
  • For most digital nerve blocks, either 1% lidocaine or 0.25% bupivacaine can be used.
  • 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.

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Reassess and document the neurovascular status of the digit.

  • 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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