injuries poisoning
How To Do a Digital Nerve Block
Step by Step Description of Procedure
Check sensation of the finger (palmar and dorsal surfaces). Wear gloves and use appropriate barrier precautions. Cleanse the site with antiseptic solution. Place the hand and wrist prone (palm down). On one side of the finger, insert the needle perpendicularly into the dorsal web space, adjacent to the medial aspect of the metacarpal head. Slowly inject about 1 mL of anesthetic to block the dorsal digital nerve. Then continue to advance the needle downward into the palmar space, while slowly injecting another 1.5 mL of anesthetic to block the palmar digital nerve. Take care not to penetrate the palmar aspect of the finger. To complete the digital block, duplicate the needle insertion and injection on the other side of the finger. Place the hand and wrist supine (palm facing up). Identify the digital-palmar crease (where the finger joins the palm). If necessary, have the patient flex the finger against resistance to make the crease more prominent. Insert the needle vertically at the midpoint of the crease and advance the tip subcutaneously. Aspirate to exclude intravascular placement, and then slowly inject about 3 mL of anesthetic. Massage the injection area to spread the anesthesia. If paresthesia occurs during needle insertion,withdraw the needle 1 to 2 mm before injecting. Allow about 5 to 10 minutes for the anesthetic to take effect. (For more details on digital anesthesia, see reference [ References ].) 