Single Injection Digital Nerve Block

    NextPrevious

    Single Injection Digital Nerve Block

    Although not a difficult procedure, the traditional approach to a digital nerve block involves two painful injections to the the digital nerves on either side of a finger, and may yield inconsistent results. An alternative, the flexor tendon sheath injection, requires slightly more skill and a slightly more painful injection. But lo, another (not new) approach may yield better results with less effort. A single subcutaneous injection of 2-3cc of lidocaine into the volar aspect of the base of the injured finger (technique below) works as well if not better than the traditional two injection approach according to a (small) 2010 RCT. Try it next time you need to anesthetize a finger.

    Screen Shot 2016-04-04 at 2.50.25 PM

    (A) Landmark. Identify the proximal skin crease on the volar aspect of the injured finger.
    (B) After cleaning the skin, use one hand to gently pinch the soft tissues of the finger just distal to the skin crease.
    (C) Insert the needle (25G) just beneath the skin at the midpoint of the skin crease. Inject 2–3 millilitres of warmed 0.5% bupivacaine into the soft tissues.
    (D) Massage the anaesthetic into the soft tissues.

    Read More:
    Cannon B, Chan L, Rowlinson JS, Baker M, Clancy M (2010). Digital anaesthesia: one injection or two? Emergency medicine journal: EMJ, 27 (7), 533-6 PMID: 20360491.

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • Lewis Leads & Invisible P’s

      You ever have a tough time visualizing P waves on EKGs? Have no fear, a Lewis Lead EKG might just be the thing you need! The Lewis Lead (aka S5) is a modified EKG obtained in a mannerRead more

    • Head Scratcher of a Head CT?

      Hey there guys and gals and welcome back to my channel! If you’re like me and TERRIBLE at reading your own imaging studies, settle in for a quick 20 minute run down for all thoseRead more

    • Central Line Troubleshooting. Beyond the Basics.

      Needle, wire, nick, dilate, catheter. Sounds simple right? However, simple doesn’t always mean easy. Placing a central line on a mannequin can be much easier than the 250lb ESRD patient with peripheral vascular disease andRead more

    • Narcan Overdose. Too Much of a Good Thing?

      What do smack, dragon, horse, salt, brown sugar, china white, and black pearl have in common? That’s right… they are all nicknames for heroin. We all know that Naloxone (Narcan) is a useful antidote inRead more

    • Health Information Exchange: Quest for the Omni-Chart.

      Have you ever opened a chart of a very sick or obtunded patient, only to find it completely blank? Of course you have…probably at some point today. The minor panic that having to find vitalRead more

    • Clinical Decision Support…your daily helper.

      Continuing with the theme of clinical informatics, today we will touch on the topic of Clinical Decision Support Systems (CDSS), or sometimes just called Clinical Decision Support (CDS). The basic premise of clinical decision supportRead more

    • What Is Clinical Informatics?

      If you loved the super sexy topic of cerumen impaction yesterday…Well, hold on to your socks, because today we will continue our rousing educational foray by tackling the riveting question: What is Clinical Informatics? ShallRead more

    • Cerumen Impaction: an Update.

      The last time www.sinaiem.org addressed the topic of cerumen (ear wax) impaction was in 2013. See this post: http://sinaiem.org/50yo-man-with-chest-pain-and-also-with-r-ear-pain/  If you’re like me, you likely believe that the world of cerumen impaction is a rather staticRead more

    NextPrevious