Two Injection Digital Block Versus Single Subcutaneous Palmar Injection Block for Finger Lacerations

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2016 Oct 7

PMID 27709248

Citations 4

Authors

O M Okur

A Sener

H S Kavakli

G K Celik

N O Dogan

F Icme

G P Gunaydin

Affiliations

Soon will be listed here.

Abstract

Purpose: We aimed to compare two digital nerve block techniques in patients due to traumatic digital lacerations.

Methods: This was a randomized-controlled study designed prospectively in the emergency department of a university-based training and research hospital. Randomization was achieved by sealed envelopes. Half of the patients were randomised to traditional (two-injection) digital nerve block technique while single-injection digital nerve block technique was applied to the other half. Score of pain due to anesthetic infiltration and suturing, onset time of total anesthesia, need for an additional rescue injection were the parameters evaluated with both groups. Epinephrin added lidocaine hydrochloride preparation was used for the anesthetic application. Visual analog scale was used for the evaluation of pain scores. Outcomes were compared by using Mann-Whitney U test and Student t-test.

Results: Fifty emergency department patients ≥18 years requiring digital nerve block were enrolled in the study. Mean age of the patients was 33 (min-max: 19-86) and 39 (78 %) were male. No statistically significant difference was found between the two groups in terms of our main parameters; anesthesia pain score, suturing pain score, onset time of total anesthesia and rescue injection need.

Conclusion: Single injection volar digital nerve block technique is a suitable alternative for digital anesthesias in emergency departments.

Citing Articles

Comparison of pain and extent of anesthesia in digital blocks for isolated finger lacerations: A randomized controlled trial.

Jarragh A, Lari A, Burhamah W, Alherz M, Nouri A, Alshammari Y Turk J Emerg Med. 2022; 22(3):125-130.

PMID: 35936956 PMC: 9355069. DOI: 10.4103/tjem.tjem_344_21.

Digital nerve blocks: A systematic review and meta-analysis.

Borbon T, Qu P, Coleman-Satterfield T, Kearney R, Klein E J Am Coll Emerg Physicians Open. 2022; 3(4):e12753.

PMID: 35795710 PMC: 9249376. DOI: 10.1002/emp2.12753.

[Oberst's block anesthesia].

Saul D, Roch J, Lehmann W, Dresing K Oper Orthop Traumatol. 2019; 32(1):18-22.

PMID: 31650198 DOI: 10.1007/s00064-019-00633-y.

Updates in emergency department laceration management.

Otterness K, Singer A Clin Exp Emerg Med. 2019; 6(2):97-105.

PMID: 30947489 PMC: 6614056. DOI: 10.15441/ceem.18.018.

References

Williams J, Lalonde D . Randomized comparison of the single-injection volar subcutaneous block and the two-injection dorsal block for digital anesthesia. Plast Reconstr Surg. 2006; 118(5):1195-1200. DOI: 10.1097/01.prs.0000237016.00941.96. View

Lalonde D, Wong A . Local Anesthetics: What's New in Minimal Pain Injection and Best Evidence in Pain Control. Plast Reconstr Surg. 2014; 134(4 Suppl 2):40S-49S. DOI: 10.1097/PRS.0000000000000679. View

Sener A, Demircan A, Keles A, Bildik F, Karakurt K . Comparison of local infiltration anesthesia and peripheral nerve block: a randomized prospective study in hand lacerations. Turk J Med Sci. 2015; 45(3):694-9. View

Klein J . The tumescent technique. Anesthesia and modified liposuction technique. Dermatol Clin. 1990; 8(3):425-37. View

Mann T, Hammert W . Epinephrine and hand surgery. J Hand Surg Am. 2012; 37(6):1254-6. DOI: 10.1016/j.jhsa.2011.11.022. View

Youha S, Lalonde D . Update/Review: changing of use of local anesthesia in the hand. Plast Reconstr Surg Glob Open. 2014; 2(5):e150. PMC: 4174079. DOI: 10.1097/GOX.0000000000000095. View

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). 2008; 2(1):5-11. PMC: 2526033. DOI: 10.1007/s11552-006-9012-4. View

Chale S, Singer A, Marchini S, McBride M, Kennedy D . Digital versus local anesthesia for finger lacerations: a randomized controlled trial. Acad Emerg Med. 2006; 13(10):1046-50. DOI: 10.1197/j.aem.2006.06.048. View

Bashir M, Ahmad Khan F, Afzal S, Khan B . Comparison of traditional two injections dorsal digital block with volar block. J Coll Physicians Surg Pak. 2008; 18(12):768-70. DOI: 12.2008/JCPSP.768770. View

10.

BAS H, Kleinert J . Anatomic variations in sensory innervation of the hand and digits. J Hand Surg Am. 1999; 24(6):1171-84. DOI: 10.1053/jhsu.1999.1171. View

11.

Yin Z, Zhang J, Kan S, Wang P . A comparison of traditional digital blocks and single subcutaneous palmar injection blocks at the base of the finger and a meta-analysis of the digital block trials. J Hand Surg Br. 2006; 31(5):547-55. DOI: 10.1016/j.jhsb.2006.06.001. View

12.

Robson A, Bloom P . Suturing of digital lacerations: digital block or local infiltration?. Ann R Coll Surg Engl. 1990; 72(6):360-1. PMC: 2499269. View

13.

Bhatti A . Painless method of digital block. Plast Reconstr Surg. 2007; 119(1):444-445. DOI: 10.1097/01.prs.0000233621.40366.a4. View

14.

Lalonde D, Wong A . Dosage of local anesthesia in wide awake hand surgery. J Hand Surg Am. 2013; 38(10):2025-8. DOI: 10.1016/j.jhsa.2013.07.017. View

15.

Harbison S . "Transthecal digital block: flexor tendon sheath used for anaesthetic infusion". J Hand Surg Am. 1991; 16(5):957. DOI: 10.1016/s0363-5023(10)80172-8. View

16.

Brutus J, Baeten Y, Chahidi N, Kinnen L, Ledoux P, Moermans J . Single injection digital block: comparison between three techniques. Chir Main. 2002; 21(3):182-7. DOI: 10.1016/s1297-3203(02)00107-5. View

17.

Cannon B, Chan L, Rowlinson J, Baker M, Clancy M . Digital anaesthesia: one injection or two?. Emerg Med J. 2010; 27(7):533-6. DOI: 10.1136/emj.2009.072850. View

18.

Botte M, Cohen M, Lavernia C, von Schroeder H, Gellman H, Zinberg E . The dorsal branch of the ulnar nerve: an anatomic study. J Hand Surg Am. 1990; 15(4):603-7. DOI: 10.1016/s0363-5023(09)90022-3. View

19.

Tzeng Y, Chen S . Tumescent technique in digits: a subcutaneous single-injection digital block. Am J Emerg Med. 2011; 30(4):592-6. DOI: 10.1016/j.ajem.2011.02.009. View