Nerve Block Methodology


Not too long ago someone indicated that they had a different method than the usual volar/dorsal technique for a digital nerve block.  Getting beyond the baggage of that thread, let's have a useful, positive, and open discussion.

My own experience was at the hands of a professional piercer and his assistant.  The piercer has experience with implants, including digital magnets.  He did not use the volar/dorsal or transthecal techniques, instead he injected lido with epi into the fingertips.  I'll say that it was unpleasant, but I do think there were advantages to it.  Having the block localized to the fingertip left me able to use the fingers to grip my steering wheel on my two-hour trip back home from the piercing parlour and the local use of epinephrine cut back bleeding dramatically (I think this is an advantage and disadvantage, it made his work easier, but you don't have the blood to help cleanse the wound).  Overall, I like this method, but at the time it was disconcerting because I expected the volar/dorsal technique.  I'd like to see some input from the resident experts, @Cassox in particular.


  • I won't bother going into detail about why piercers shouldn't be used a resource in terms of anaesthetic and such as non of their practice is standardized. There is some evidence that epi is safe to use in digits but the standard is that epi shouldn't be used. As to being able to drive after, you should have had the same thing if a nerve block was used. You regain use of hands after 20 minutes, albeit they are soar, regardless of method. I used a local injection but that was due to complications. The nerve block is standard and works well for a reason. A local injection is also viable though unless i'm misinformed. 
  • To answer this question, we really need to delve into very particular terminology. What you've described, an injection directly into the area in which anesthesia is desired, is not a nerve block. What your describing is technically local infiltration. The difference is that the anesthetic is being applied directly to the terminal nerve endings rather than farther up the nerve pathway.

    Don't sweat it though... this doesn't mean it's bad. The closest thing to a criticism I'd apply to using local infiltration is that it lacks finesse.. and honestly I don't think the majority of people in this field give half a fuck about finesse. I often use local infiltration too along with a block if I'm working quickly. The onset is seriously quicker, but the duration is much shorter and the level of anesthesia decreased. I've found nerve blocks to require far less lido, last longer, and that people report far less pain.

    I do however have to criticize the use of epinephrine. I get it, really. Vasoconstriction is nice. The proper use of a tourniquet achieves a bloodless field too, and without the added risk of infection, necrosis, cardiac side effects etc. Some physicians who specialize in plastic surgery of the hands for example do use epinephrine, but most don't. No one here is at a level of experience and education that they should feel free to buck the system in terms of standardized medical practices. Sure, there are even medical journal articles discussing how at times epinephrine can be really beneficial on peripheral regions such as the penis, nose, ears, and fingers. These journals weren't written for you though. Or for me for that matter. If people continue to use epinephrine, it's inevitable someone is going to lose a finger. I strongly advise against it. Usually, people aren't using lidocaine with epinephrine because they prefer it. It's usually a sourcing issue. This is laziness as far as I'm concerned and I wouldn't trust someone to cut me with such a cavalier attitude.

    Short version: That's not a nerve block, but it's ok. Don't use epinephrine.

  • Well, a question that occurs to me is, is there any way to neutralize the epiin lido with epi, without spending a bunch of money, ruining the solution, or sourcing it without the epiin the first place?
  • Perhaps. The real question is... would the process be cheaper or easier than buying a vial from dt?
  • edited March 2015
    Something that's never brought up here that I think should be noted is that there ARE potentially harmful drug interactions for lidocaine.  According to, there are 228 other drugs that are known to potentially interact with lidocaine, 20 of which are noted as "major" interactions.

    I'm no expert (obviously) and I don't want to be an alarmist, but it worries me that we never talk about this aspect of lidocaine injections.
  • I wanted to mention this but considering starting a new thread for relatively trivial information would be senseless I felt this would be a good place to do so.

    Regarding sourcing lidocaine solution: There are many offshore sites that distribute lidocaine to individuals regardless of whether one has a prescription. I'm sure many bio-hackers are aware of this. I also tend to see quite a few questions about extracting lidocaine from OTC topical solutions.

    My advice: avoid these options.

    Offshore "pharmacies" tend to be, naturally, shady. Most Grey Market pharmaceutical distributors are. As such, you can never be sure of the quality of these products. Similarly, attempting to extract lidocaine, remove epinephrine, etc is likely to result in a product unsuitable for use, let alone internal use. Unless you have a strong background in chemistry or pharmacology (ppreferably both) and access to NMR or similar high-precision analytical equipment your best bet is to err on the side of caution and stick to reliable sources (such as DT).

    That being said, if you insist on taking a DIY approach with anaesthetic, there are local sources for lidocaine hcl powder. I trust these sources far more than I trust offshore pharmacies, but even that is pushing it. Request lab results, and if they decline have a sample tested elsewhere or move on.
  • Heheheh, there is actually a thread about this thing already somwhere ;) Someone was discussing extracting lidocaine. It was actually a good thread, in terms of getting into the chemistry of it, but yeah, just get it from a solid source, everyone agrees. 

    If you have the internet, you can get the things you need to do things properly. Always follow protocol. Always use the right tools.
  • Is @Amal willing to supply just the saline and lidocaine vials? I plan on (eventually) testing a few things that might reduce the time needed for inducing anesthesia, or eliminating the need for needles in general. At this time, only one of the options I'm exploring as an alternative for part or all of the anesthetic introduction portion of an implant procedure seems promising. It's also, as was mentioned, a major pain to source lidocaine from anywhere but Dangerous Things. 
  • Hi @TheGreyKnight and @atimeoflight - I stopped providing the HCL powder as an option simply because I could not source or guarantee proper pyrogenic-free saline. You can get sterile saline easy enough but that doesn't mean it will not contain pyrogens. Google it. Pyrogens are potentially lethal when injected. 

    I did consider, for a time, using injectable saline (the kind hanging in bags in hospital TV shows) but transferring that to a clean sterile vial is impossible for me. Without a controlled air hood setup it will always be contaminated to some degree, so shelf life is basically nil. It's better to just get the commercial stuff, if you can...

    So, I went out and found a reputable source for commercial Xylocaine (lidocaine 2%) 5mL ampoules and provide them via the PMK on the site. Lidocaine is not a controlled substance - look it up on the DEA schedule, it's not there... therefore it is legal to sell and own and walk around with here in the USA, just not administer or give medical advice, etc. If you live in another country, I will ship it, but you're on your own with customs... they may seize it. I simply mark it as PMK in the description and so far it's been ok... but again, it's up to you to evaluate laws in your own country, just as it's your choice to order and your choice to do whatever you do with it.
  • Is there any chance you could point me to said source? I've been unable to find a source that provides to anyone other than official medical institutions...
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