Finger Digital Block

General Surgery Online Notebook

by Calvin Lee, MD, Board Certified General Surgeon, Modesto, CA and advice from Tammy Wu, MD, Board Certified Plastic Surgeon, Modesto, CA.

This information is intended for medical professionals and medical students only.  I have written this based on my experience and the target audience is the medical students and physician assistant students that have been under my guidance rotating through the medical hospitals and offices in Modesto, Turlock, and Stockton, California.

First the issue of epinephrine in the lidocaine used for the block.  It is controversial, but the idea is not to use epinephrine for fear of causing ischemia.  For starters, I would recommend not using any epinephrine when injecting lidocaine for a digital block, but know that there are doctors who use epinephrine for such blocks, and it is not considered "wrong" technique.  In general the closer to the tip that the block is provided, the higher the risk of ischemia.  Thus, I'm describing here the base of finger digital block.

Digital Anesthesia with Epinephrine: An Old Myth Revisited." The Journal of the American Academy of Dermatology 2004;51:755-759

Equipment needed for digital block

• Sterile towels
• 4x4 gauze packs
• Syringe 5cc or 10 cc
• 27 gauge needle or 30 gauge needle
• Sterile gloves

Steps for performing a digital block at base of finger

• Clean the finger with betadine solution
• Obtain a 27 gauge or 30 gauge needle and fill a syringe with 1% lidocaine plain.
• Inject at the midpoint between the back and front of the finger at the base of the finger (by the web space)
• Inject straight in to the periosteum, then pull back without taking the needle out of the skin and fan the needle dorsally; then do the same in the palmar side.
• The start on the middle of the dorsal side of the finger and inject to the other side of the finger that doesn't have any local.
• Repeat the initial injection technique the opposite side of the finger (midpoint between the back and front of the finger at the base)
• This creates a ring of lidocaine around the base of the finger.
• Total amount of lidocaine infiltrated would be around 3cc to 4cc's
• Wait about 5-10 minutes for the analgesic effect to take place
• When sewing up a laceration, make sure the edges are everted
• Use 5-0 nylon as a suggestion.

Links on the web about local anesthesia and regional nerve block

http://www.emedicine.com/derm/topic824.htm

http://www.nysora.com/techniques/digital_block/

Websites by Dr. Calvin Lee, Modesto General Surgeon, various topics

http://www.modestosurgery.com/webpages/ - a collection and description of Dr. Lee's websites - most related to Modesto.

http://www.surgerytoday.com - Surgical Artistry's main webpage.

http://www.modestosurgery.com - Dr. Lee's main page.

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Last modified:  12/30/2006