How To Do a Digital Nerve Block

Laceration or other surgically treated lesion of a finger*

Ring removal

History of allergy to the anesthetic agent or delivery vehicle (choose a different anesthetic)

Absence of anatomic landmarks needed to guide needle insertion (eg, due to trauma)

Infection in the path of needle insertion: Use procedural sedation How To Do Procedural Sedation and Analgesia Procedural sedation and analgesia (PSA) is the administration of a short-acting sedative-hypnotic or dissociative agent, with or without an analgesic, for patients undergoing anxiety-provoking... read more or other anesthesia.

Coagulopathy*: When feasible, correct prior to procedure, or use a different means of analgesia.

Adverse reaction to the anesthetic or delivery vehicle Local anesthesia for laceration treatment (eg, allergic reaction to the anesthetic [rare] or to methylparaben [a preservative])

Toxicity due to anesthetic overdose (eg, seizure, cardiac arrhythmias) or sympathomimetic effects due to epinephrine (if using an anesthetic-epinephrine mixture)

Intravascular injection of anesthetic or epinephrine

Hematoma

Neuritis

Spread of infection, by passing the needle through an infected area

Nonsterile gloves

Barrier precautions as indicated (eg, face mask, safety glasses or face shield, cap and gown)

Antiseptic solution (eg, chlorhexidine, povidone-iodine, alcohol)

Injectable local anesthetic* such as lidocaine 2% with epinephrine† 1:100,000, or for longer- duration anesthesia, bupivacaine 0.5% with epinephrine† 1:200,000

Syringe (eg, 3 mL) and needle (eg, 25 or 27 gauge) for anesthetic injection

Document any preexisting nerve deficit before doing a nerve block.

Stop the nerve block procedure if you are unsure where the needle is or if the patient is uncooperative. Consider sedation How To Do Procedural Sedation and Analgesia Procedural sedation and analgesia (PSA) is the administration of a short-acting sedative-hypnotic or dissociative agent, with or without an analgesic, for patients undergoing anxiety-provoking... read more for patients who are unable to cooperate.

Each finger is innervated by 4 nerves: bilateral dorsal and palmar digital.

The palmar digital nerves originate from the medial and ulnar nerves.

The dorsal digital nerves originate from the cutaneous branches of the ulnar and radial nerves that wrap around to innervate the dorsum of the hand.

Digital nerve blocks are traditionally placed in the web space adjacent to the metacarpal head, with one needle insertion on each side of the finger.

The middle 3 fingers can be anesthetized by blocking only the palmar digital nerves of those fingers.

The thumb and little finger are anesthetized by blocking both their palmar and dorsal digital nerves.

Position the patient with the arm supported. The hand is supinated for volar injections and pronated and flat for dorsal injections (eg, ring block).

Check sensation of the finger (palmar and dorsal surfaces).

Wear gloves and use appropriate barrier precautions.

Cleanse the site with antiseptic solution.

Ensure hemostasis at the injection site.

Instruct patient regarding anticipated time to anesthesia resolution.

To minimize the risk of needle breakage, do not bend the needle, insert it to its full depth (ie, to the hub), or attempt to change direction of the needle while it is inserted.

To help prevent nerve injury or intraneural injection, instruct patients to report paresthesias or pain during the procedure.

To help prevent intravascular injections, aspirate before injecting.

Minimize the pain of injection Local anesthesia for laceration treatment by injecting slowly (eg, 30 to 60 seconds), warming the anesthetic solution to body temperature, and buffering the anesthetic.