Digital nerve block
- Robert Baldor, MD
Robert Baldor, MD
- Professor of Family Medicine and Community Health
- University of Massachusetts Medical School
- Barbara M Mathes, MD, FACP, FAAD
Barbara M Mathes, MD, FACP, FAAD
- Clinical Associate, Dermatology
- University of Pennsylvania
- Professor, Fox Chase Cancer Center
- Temple University
- Assistant Secretary Treasurer
- American Academy of Dermatology
The digital nerve block is a procedure in which an anesthetic solution is injected into the base of a finger or toe to provide regional anesthesia. Other methods to anesthetize locally the tissues of the digits vary from applications of topical agents to subcutaneous injections of anesthetic solutions. Due to the extreme sensitivity of the palmar surfaces of the digits, a local injection may be painful and ineffective at anesthetizing the tissues. The injection sites for the digital nerve block are typically less painful; furthermore, they provide a larger area of consistent anesthesia throughout the operative region.
The performance of digital nerve blocks is reviewed here. Specific anesthetics, peripheral nerve blocks of larger nerves, and the management of specific conditions such as nail bed injuries are discussed separately. (See "Infiltration of local anesthetics" and "Overview of peripheral nerve blocks" and "Management of fingertip injuries" and "Closure of skin wounds with sutures".)
INDICATIONS, CONTRAINDICATIONS, AND PRECAUTIONS
A digital nerve block is indicated for the treatment and repair of many acute conditions, including finger or toe lacerations beyond the mid-proximal phalanx, nail bed injuries, paronychias, nail avulsions, and foreign bodies of the digit.
- Compromised digital circulation
- Infection of the skin or tissues through which the needle will pass
- Allergy to the anesthetic agent
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- Salasche, SJ. Surgery. In: Nails: Therapy, Diagnosis, Surgery, 2nd, Scher, RK, Daniels, CR (Eds), WB Saunders, Philadelphia 1997. p.329.
- INDICATIONS, CONTRAINDICATIONS, AND PRECAUTIONS
- ANESTHETIC AGENTS
- General issues
- Use of epinephrine
- Pain with administration
- Informed consent
- Skin preparation
- DIGITAL BLOCK PROCEDURES
- General considerations
- - Finger web space block (traditional digital block)
- - Transthecal block
- - Subcutaneous block
- - Choice of technique
- - Thumb
- Great toe
- - Three-sided toe block
- - Four-sided ring block
- Other toes
- - Toe digital block
- - Unilateral digital block
- Wing block procedure