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
- Secretary Treasurer
- American Academy of Dermatology
- Section Editor
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
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 "Subcutaneous infiltration of local anesthetics" and "Overview of peripheral nerve blocks" and "Management of fingertip injuries" and "Closure of minor 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.
- Grant's Atlas of Anatomy, 14th ed, Agur A, Dalley A (Eds), Lippincott Williams & Wilkins, Philadelphia 2017.
- Thomson CJ, Lalonde DH. Randomized double-blind comparison of duration of anesthesia among three commonly used agents in digital nerve block. Plast Reconstr Surg 2006; 118:429.
- Alhelail M, Al-Salamah M, Al-Mulhim M, Al-Hamid S. Comparison of bupivacaine and lidocaine with epinephrine for digital nerve blocks. Emerg Med J 2009; 26:347.
- Valvano MN, Leffler S. Comparison of bupivacaine and lidocaine/bupivacaine for local anesthesia/digital nerve block. Ann Emerg Med 1996; 27:490.
- Altinyazar HC, Ozdemir H, Koca R, et al. Epinephrine in digital block: color Doppler flow imaging. Dermatol Surg 2004; 30:508.
- Prabhakar H, Rath S, Kalaivani M, Bhanderi N. Adrenaline with lidocaine for digital nerve blocks. Cochrane Database Syst Rev 2015; :CD010645.
- Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg 2001; 108:114.
- Krunic AL, Wang LC, Soltani K, et al. Digital anesthesia with epinephrine: an old myth revisited. J Am Acad Dermatol 2004; 51:755.
- Muck AE, Bebarta VS, Borys DJ, Morgan DL. Six years of epinephrine digital injections: absence of significant local or systemic effects. Ann Emerg Med 2010; 56:270.
- Chowdhry S, Seidenstricker L, Cooney DS, et al. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg 2010; 126:2031.
- Mohan PP. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Epinephrine in digital nerve block. Emerg Med J 2007; 24:789.
- Lalonde D, Bell M, Benoit P, et al. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am 2005; 30:1061.
- Wilhelmi BJ, Blackwell SJ, Miller J, et al. Epinephrine in digital blocks: revisited. Ann Plast Surg 1998; 41:410.
- Thomson CJ, Lalonde DH, Denkler KA, Feicht AJ. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg 2007; 119:260.
- Sonohata M, Nagamine S, Maeda K, et al. Subcutaneous single injection digital block with epinephrine. Anesthesiol Res Pract 2012; 2012:487650.
- Fitzcharles-Bowe C, Denkler K, Lalonde D. Finger injection with high-dose (1:1,000) epinephrine: Does it cause finger necrosis and should it be treated? Hand (N Y) 2007; 2:5.
- Ilicki J. Safety of Epinephrine in Digital Nerve Blocks: A Literature Review. J Emerg Med 2015; 49:799.
- Zilinsky I, Bar-Meir E, Zaslansky R, et al. Ten commandments for minimal pain during administration of local anesthetics. J Drugs Dermatol 2005; 4:212.
- Bartfield JM, Ford DT, Homer PJ. Buffered versus plain lidocaine for digital nerve blocks. Ann Emerg Med 1993; 22:216.
- Cornelius P, Kendall J, Meek S, Rajan R. Alkalinisation of lignocaine to reduce the pain of digital nerve blockade. J Accid Emerg Med 1996; 13:339.
- Waldbillig DK, Quinn JV, Stiell IG, Wells GA. Randomized double-blind controlled trial comparing room-temperature and heated lidocaine for digital nerve block. Ann Emerg Med 1995; 26:677.
- Browne J, Fung M, Donnelly M, Cooney C. The use of EMLA reduces the pain associated with digital ring block for ingrowing toenail correction. Eur J Anaesthesiol 2000; 17:182.
- Serour F, Ben-Yehuda Y, Boaz M. EMLA cream prior to digital nerve block for ingrown nail surgery does not reduce pain at injection of anesthetic solution. Acta Anaesthesiol Scand 2002; 46:203.
- Morrison WG. Transthecal digital block. Arch Emerg Med 1993; 10:35.
- Hill RG Jr, Patterson JW, Parker JC, et al. Comparison of transthecal digital block and traditional digital block for anesthesia of the finger. Ann Emerg Med 1995; 25:604.
- Low CK, Vartany A, Engstrom JW, et al. Comparison of transthecal and subcutaneous single-injection digital block techniques. J Hand Surg Am 1997; 22:901.
- Keramidas EG, Rodopoulou SG, Tsoutsos D, et al. Comparison of transthecal digital block and traditional digital block for anesthesia of the finger. Plast Reconstr Surg 2004; 114:1131.
- Sonohata M, Asami A, Ogawa K, et al. Single injection digital block: is a transthecal injection necessary? J Hand Surg Eur Vol 2009; 34:94.
- Antevy PM, Zuckerbraun NS, Saladino RA, Pitetti RD. Evaluation of a transthecal digital nerve block in the injured pediatric patient. Pediatr Emerg Care 2010; 26:177.
- Cannon B, Chan L, Rowlinson JS, et al. Digital anaesthesia: one injection or two? Emerg Med J 2010; 27:533.
- 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; 30:581.
- Brutus JP, Baeten Y, Chahidi N, et al. Single injection digital block: comparison between three techniques. Chir Main 2002; 21:182.
- Martin SP, Chu KH, Mahmoud I, et al. Double-dorsal versus single-volar digital subcutaneous anaesthetic injection for finger injuries in the emergency department: A randomised controlled trial. Emerg Med Australas 2016; 28:193.
- Okur OM, Şener A, Kavakli HŞ, et al. Two injection digital block versus single subcutaneous palmar injection block for finger lacerations. Eur J Trauma Emerg Surg 2016.
- Whiteley B, Rees S. A randomized controlled trial to compare two techniques for partial digital local anesthetic blocks. J Foot Ankle Surg 2010; 49:143.
- Salasche SJ. Surgery. In: Nails: Diagnosis, Therapy, Surgery, 3rd, Scher RK, Daniel CR (Eds), Saunders, Philadelphia 2005. p.267.
- 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