Use of this content is subject to the Terms and Conditions of the MD Consult web site.
Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
< Previous Next >

DIGITAL NERVE BLOCK

Perspective

Digital nerve block is a commonly employed block in emergency departments, although it is infrequently used by anesthesiologists. It can be used for any surgery that requires a digital operation. However, its widest use is for repair of lacerations.

Patient Selection.

Again, the most common use for this block is in emergency departments, although its use may be appropriate in an occasional elective surgical patient with a single-digit surgical problem.

Pharmacologic Choice.

As with any of the more peripheral upper extremity blocks, low concentrations of any of the amide local anesthetics are appropriate for digital block, with a strong recommendation to avoid epinephrine-containing solutions.

Placement

Anatomy.

As illustrated in Figure 8-6 , the digital nerves can be conceptualized as running at the “corners” of the proximal phalanx. The nerves are found along arteries and veins and are the distal continuation of both median and ulnar nerves.

Click to view full size figure

Figure 8-6  Digital block: anatomy and needle insertion.


Position.

Digital nerve block is most effectively carried out with the hand pronated. the skin over the dorsum of the finger is fixed less tightly to the underlying structures than it is on the ventral surface of the digit.

Needle Puncture.

Skin wheals are raised at the dorsolateral borders of the proximal phalanx, and a blunt-beveled, small-gauge, short needle is inserted at the dorsal surface of the lateral border of the phalanx. Infiltration of both the dorsal and ventral branches of the digital nerve is carried out bilaterally, and a total of 1 to 2 mL at each site should be sufficient for the block.

Potential Problems.

It is emphasized once again that epinephrine-containing solutions should not be used for digital nerve block.

Pearls

Digital nerve blocks should be used principally for emergency department procedures, and comprehensive anesthesia care requires at least familiarity with the technique.

< Previous Next >

About MD Consult Contact Us Terms and Conditions Privacy Policy Registered User Agreement
Copyright © 2007 Elsevier Inc. All rights reserved. www.mdconsult.com 
Bookmark URL: /das/book/0/view/1353/27.html/top