Morning Report: 1/28/2014

Thanks to Dr. Basile for today’s Morning Report!

New Approach to the Digital Block

Traditional digital nerve block:

–        two injections where you hit all four digital nerves with injections on both sides of the finger at MCP joint

–       Does not work at least 10% of the time

Single injection volar approach:

–       Single injection

–       Less amount of anesthetic used

–       Subcutaneous injection to volar aspect of proximal digit or at proximal skin crease

Article described in EMRAP:

Cannon B et al. Digital anaesthesia: one injection or two? Emerg Med J. 2010 Jul;27(7):533-6

–       2-3 cc anesthetic into flexor tendon at proximal crease on volar aspect of digit and massage into the tendon sheath

–       Do not go all the way to the bone

–       Randomized-controlled trial

–       Blinded physician to type of block (traditional vs single injection subcutaneous)

–       Outcomes were good anesthesia at 5 and 10 minutes as well as patient satisfaction and self-reported distress

–       76% of patients in the single injection group were adequately anesthetized at 5 min vs 65% in traditional technique

–       89% in the single injection group at 10 min compared to 82% in the traditional group

–       Patient satisfaction scores and self-reported distress were better in the single injection group

Tzeng YS, Chen SG.  Tumescent technique in digits:  a subcutaneous single-injection digital block.  Am J Emerg Med.  2012 May; 30 (4): 592-6.

–       Prospective study of subcutaneous single-injection digital block of 3-3.5 ml anesthetic into volar aspect of proximal digit

–       Volume sufficient to moderately distend the skin on volar and dorsal aspects of proximal digit

–       Effectiveness was determined 5 min after injection

–       Successful in all digits (113 fingers and 10 thumbs)

–       No adverse events noted at 48 hour and one month follow up

Single injection digit block:  Easier, quicker…. PRACTICE CHANGING??????

References:

1)    Arora S, Menchine M.  Paper chase 4- digital anesthesia.  EMRAP Dec 2013.  https://www.emrap.org/episode/2013/december/paperchase4

2)    Cannon B et al. Digital anaesthesia: one injection or two? Emerg Med J. 2010 Jul;27(7):533-6

3)    Tzeng YS, Chen SG.  Tumescent technique in digits:  a subcutaneous single-injection digital block.  Am J Emerg Med.  2012 May; 30 (4): 592-6

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Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

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