Digital Block
Simulation
The simulator tests your ability to perform a ring block for the management of minor digital injuries or minor digital surgery.
Video
The video guides you through a step-by-step demonstration on how to set up and perform a digital block.
Anatomy
Review the peripheral nerve anatomy of the distal forearm and hand in relation to the carpal, metacarpal and phalangeal bones, to see the median nerve and superficial branch of the ulna nerve divide into common palmar digital nerves and terminal digital nerves.
Text
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Step 1: Preparation
1.1. Tray preparation
Before embarking on this procedure, set up your tray with the necessary equipment and/or medication in an aseptic manner.
Attach a disposable bag to the tray for the disposal of your used non-sharp materials.
1.2. Patient preparation
Check and document the limb neurological status before commencing the procedure.
Lie the patient in a comfortable position. Rest the hand on a flat surface in the pronated position and extend and abduct the fingers.
1.3. Operator preparation
Use a aseptic technique
Step 2: Cleanse the digit
Cleanse the skin from the metacarpophalangeal joint to the proximal interphalangeal joint with the antiseptic solution.
Step 3: Insert the needle and infiltrate local anesthetic
Insert the needle at the base of the dorsum of the digit, at either the lateral or the medial aspect.
Hold the needle perpendicular to the skin and advance it ventrally until the palmar aponeurosis is felt.
Aspirate to ensure that the needle is not within a blood vessel.
Slowly infiltrate 1 to 2 mL of lidocaine (lignocaine) whilst withdrawing the needle. This should produce a visible swelling.
Withdraw the needle completely.
Step 4: Repeat the procedure on the opposite side of the finger
Repeat step 3 on the opposite side of the finger but do not completely withdraw the needle at the end of the step.
Step 5: Infiltrate the dorsum of the finger
Angle the needle across the dorsum of the digit and advance it subcutaneously.
Aspirate and infiltrate 0.5 mL of lidocaine (lignocaine) whilst withdrawing the needle completely.
Massage the base of the digit to facilitate the spread of the lidocaine (lignocaine).
References
Randomized controlled trials
Knoop K, Trott A, Syverud S. Comparison of digital versus metacarpal blocks for repair of finger injuries. Ann Emerg Med 1994;23:1296-1300. PMID: 8198304
Hung VS, Bodavula VK, Dubin NH. Digital anaesthesia: comparison of the efficacy and pain associated with three digital nerve block techniques. J Hand Surg [Br]. 2005 Dec;30(6):581-4. PMID: 16131466
