Nerve block: digital block: Difference between revisions
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==Background== | |||
*Each digit is innervated by 4 nerves | |||
**2 Dorsal (10 and 2 o'clock positions) | |||
**2 Ventral - palmar or plantar (4 and 8 o'clock positions) | |||
==Indications== | ==Indications== | ||
*Need to anesthetize entire digit (finger or toe) | *Need to anesthetize entire digit (finger or toe) | ||
| Line 36: | Line 41: | ||
==See Also== | ==See Also== | ||
[[Nerve Blocks (Main)]] | |||
==References== | ==References== | ||
Revision as of 06:09, 3 July 2015
Background
- Each digit is innervated by 4 nerves
- 2 Dorsal (10 and 2 o'clock positions)
- 2 Ventral - palmar or plantar (4 and 8 o'clock positions)
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