Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Digital Nerve Block

  • Author: Dmitry Volfson, DO; Chief Editor: Meda Raghavendra (Raghu), MD  more...
 
Updated: Mar 31, 2016
 

Background

Digital nerve blocks are important tools for the emergency medicine clinician. Injuries or infections of the digits are extremely common. Adequate analgesia is essential to properly address the presenting condition and to minimize the patient's discomfort. Digital blocks are useful in many scenarios in which local infiltration of an anesthetic would require several injections into the already painful site of injury. Furthermore, local infiltration around the wound may create increased swelling, making the repair more difficult. Several techniques are available for performing digital blocks.

Relevant anatomy

Each digit is innervated by 4 digital nerves. In the upper extremity, the digital nerves arise from the median, ulnar, and radial nerves. The 2 palmar digital nerves innervate the palmar aspect of the digit and the nail bed, whereas the dorsal nerves innervate the dorsum of the digit (see images below). The tibial and peroneal nerves branch off into the digital nerves of the lower extremities, which follow a pattern of distribution analogous to those of the upper extremity.[1]

Palmar digital nerves. Palmar digital nerves.
Dorsal digital nerves. Dorsal digital nerves.
Next

Indications

Digital blocks are indicated for any minor surgery or procedure of the digits. These include, but are not limited to, the following:

Previous
Next

Contraindications

See the list below:

  • Compromised digit circulation
  • Infected injection site
  • Known allergy to anesthetic
Previous
Next

Best Practices

See the list below:

  • Avoid epinephrine use in the digits; a clamped Penrose drain can be used to limit bleeding.
  • Limit the patient’s discomfort by using a smaller needle, injecting slowly, and using small amounts of anesthetics.
  • Anesthesia of the great toe is more difficult to achieve and requires 3-sided/4-sided ring blocks.
  • Use of sterile technique is essential to limit the risk of introducing infections (especially with the transthecal block).
Previous
 
 
Contributor Information and Disclosures
Author

Dmitry Volfson, DO Staff Physician, Department of Emergency Medicine, Long Island Jewish Medical Center

Dmitry Volfson, DO is a member of the following medical societies: American Osteopathic Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Gino A Farina, MD, FACEP, FAAEM Professor of Emergency Medicine, Hofstra North Shore-LIJ School of Medicine at Hofstra University; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Laurie Scudder, DNP, NP Nurse Planner, Medscape; Senior Clinical Professor of Nursing, George Washington University

Disclosure: Nothing to disclose.

Chief Editor

Meda Raghavendra (Raghu), MD Associate Professor, Interventional Pain Management, Department of Anesthesiology, Chicago Stritch School of Medicine, Loyola University Medical Center

Meda Raghavendra (Raghu), MD is a member of the following medical societies: American Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Additional Contributors

Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. Agur A. Grant's Atlas of Anatomy. 10th ed. Lippincott Williams & Wilkins; 2003.

  2. Simpson PM, McCabe B, Bendall JC, Cone DC, Middleton PM. Paramedic-performed digital nerve block to facilitate field reduction of a dislocated finger. Prehosp Emerg Care. 2012 Jul-Sep. 16(3):415-7. [Medline].

  3. Mulroy MF, Bernards CM, McDonald SB, Salinas FV. Local anesthetics. A Practical Approach to Regional Anesthesia. 4th ed. Lippincott Williams and Wilkins; May 2008. 1.

  4. Roberts JR, Hedges JR, Chanmugam AS. Clinical Procedures in Emergency Medicine. 4th ed. Elsevier Health Sciences; October 2004.

  5. Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg. 2001 Jul. 108(1):114-24. [Medline].

  6. Motoki Sonohata, Satomi Nagamine, Kazumasa Maeda, Kenji Ogawa, Hideki Ishii, Kenji Tsunoda, et al. Subcutaneous Single Injection Digital Block with Epinephrine. Anesthesiology Research and Practice. 2012. 2012:4. [Medline].

  7. Chiu DT. Transthecal digital block: flexor tendon sheath used for anesthetic infusion. J Hand Surg [Am]. 1990 May. 15(3):471-7. [Medline].

  8. Hill RG Jr, Patterson JW, Parker JC, Bauer J, Wright E, Heller MB. Comparison of transthecal digital block and traditional digital block for anesthesia of the finger. Ann Emerg Med. 1995 May. 25(5):604-7. [Medline].

  9. Low CK, Wong HP, Low YP. Comparison between single injection transthecal and subcutaneous digital blocks. J Hand Surg [Br]. 1997 Oct. 22(5):582-4. [Medline].

  10. Dehghani M, Mahmoodian A. A revisit of transthecal digital block and traditional digital block for anesthesia of the finger. Journal of Research in Medical Sciences. Nov/Dec 2007. 12(6):

  11. Flarity-Reed K. Methods of digital block. J Emerg Nurs. 2002 Aug. 28(4):351-4. [Medline].

  12. Salasche SJ. Scher RK, Daniels CR, eds. Surgery In Nails: Treatment; Diagnosis; Surgery. 2nd ed. WB Saunders; 1997. 329.

  13. Maher AJ, Metcalfe SA, Parr S. Local anesthetic toxicity. The Foot. Dec 2008. 18:192-197.

  14. Schmidt RM, Rosenkranz HS. Antimicrobial activity of local anesthetics: lidocaine and procaine. J Infect Dis. 1970 Jun. 121(6):597-607. [Medline].

  15. Morris T, Tracey J. Lignocaine: its effects on wound healing. Br J Surg. 1977 Dec. 64(12):902-3. [Medline].

  16. Eriksson AS, Sinclair R, Cassuto J, Thomsen P. Influence of lidocaine on leukocyte function in the surgical wound. Anesthesiology. 1992 Jul. 77(1):74-8. [Medline].

Previous
Next
 
Palmar digital nerves.
Dorsal digital nerves.
Needle position for web-space block.
Needle position for transthecal block.
Modified transthecal block.
Medial injection for 3-sided digital block.
Medial to lateral injection for 3-sided digital block.
Lateral injection for 3-sided digital block.
Wing block technique.
Web-space block technique.
Table 1. Commonly Used Local Anesthetics and Their Properties[4]
AgentMaximum Adult Dose (mg)/Procedure*Onset (min)Duration
Lidocaine3002-51-2 h
Procaine5002-515-45 min
Bupivacaine1752-54-8 h
*Administer by small incremental doses.
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.