Nerve block: digital block: Difference between revisions
No edit summary |
No edit summary |
||
| Line 34: | Line 34: | ||
*Infection | *Infection | ||
*Accidental intravascular injection of anesthetic | *Accidental intravascular injection of anesthetic | ||
==See Also== | ==See Also== | ||
Revision as of 09:09, 28 June 2015
Indications
- Need to anesthetize entire digit (finger or toe)
- Laceration repair
- Dislocation/fracture reduction
- Pain control for traumatic injury
- Paronychia
- Felon
- Nail trephination
Contraindications
- Overlying skin infection
- Distortion of landmarks
Equipment Needed
- PPE
- Local anesthetic
- 27-30ga needle
- Syringe
- Iodine or chlorhexadine prep
Maximum Doses of Anesthetic Agents
| Agent | Without Epinephrine | With Epinephrine | Duration | Notes |
| Lidocaine | 5 mg/kg (max 300mg) | 7 mg/kg (max 500mg) | 30-90 min |
|
| Mepivicaine | 7 mg/kg | 8 mg/kg | ||
| Bupivicaine | 2.5 mg/kg (max 175mg) | 3 mg/kg (max 225mg) | 6-8 hr |
|
| Ropivacaine | 3 mg/kg | |||
| Prilocaine | 6 mg/kg | |||
| Tetracaine | 1 mg/kg | 1.5 mg/kg | 3hrs (10hrs with epi) | |
| Procaine | 7 mg/kg | 10 mg/kg | 30min (90min with epi) |
Epinephrine in Digital Block
- Previously, "conventional wisdom" argued that it is unsafe to use epinephrine in digital local anesthesia.
- However, many studies going back more than a decade have shown that using local anesthetic with epinephrine is safe for use in digits.[1][2][3]
- A Cochrane Review concurs that no adverse effects have been reported, but notes that the level of evidence is poor and further high quality studies are required.[4]
Procedure
Complications
- Damage to surrounding structures
- Bleeding
- Infection
- Accidental intravascular injection of anesthetic
See Also
References
- ↑ 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.
- ↑ Krunic AL, Wang LC, Soltani K, Weitzul S, Taylor RS. Digital anesthesia with epinephrine: an old myth revisited. J Am Acad Dermatol. 2004 Nov;51(5):755-9.
- ↑ Chowdhry S, Seidenstricker L, Cooney DS, Hazani R, Wilhelmi BJ. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg. 2010 Dec;126(6):2031-4
- ↑ Prabhakar H, Rath S, Kalaivani M, Bhanderi N. Adrenaline with lidocaine for digital nerve blocks. Cochrane Database Syst Rev. 2015 Mar 19;3