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.
Similar content being viewed by others
References
Lalonde DH, 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 (Epub 2013 Sep 8).
Robson AK, Bloom PA. Suturing of digital lacerations: digital block or local infiltration? Ann R Coll Surg. 1990;72:360–1.
Williams JG, Lalonde DH. Randomized comparison of the single-injection volar subcutaneous block and the two-injection dorsal block for digital anesthesia. Plast Reconstr Surg. 2006;118:1195–200.
Harbison S. Transthecal digital block: flexor tendon sheath used for anesthetic infusion (Letter). J Hand Surg Am. 1991;16:957.
Bhatti AZ. Painless method of digital block. Plast Reconstr Surg. 2007;119:444–5.
Brutus JP, Baeten Y, Chahidi N, Kinnen L, Ledoux P, Moermans JP. Single injection digital block: comparison between three techniques. Chir Main. 2002;21:182–7.
Bashir MM, Khan FA, Afzal S, Khan BA. Comparison of traditional two injections dorsal digital block with volar block. J Coll Physicians Surg Pak. 2008;18:768–70.
Mann T, Hammert WC. Epinephrine and hand surgery. J Hand Surg Am. 2012;37(6):1254–6. doi:10.1016/j.jhsa.2011.11.022 (Epub 2012 Feb 3, quiz 1257).
Al Youha S, Lalonde DH. Update/review: changing of use of local anesthesia in the hand. Plast Reconstr Surg Glob Open. 2014;2(5):e150. doi:10.1097/GOX.0000000000000095 (eCollection 2014 May).
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–9S. doi:10.1097/PRS.0000000000000679.
Chale S, Singer AJ, Marchini S, McBride MJ, Kennedy D. Digital versus local anesthesia for finger lacerations: a randomized controlled trial. Acad Emerg Med. 2006;13:1046–50.
Şener A, Demircan A, Keleş 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. doi:10.3906/sag-1312-24.
Yin ZG, Zhang JB, Kan SL, 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;31:547–55.
Bas H, Kleinert JM. Anatomic variations in sensory innervation of the hand and digits. J Hand Surg Am. 1999;24A:1171–84.
Botte MJ, Cohen MS, Lavernia CJ, von Schroeder HP, Gellman H, Zinberg EM. The dorsal branch of the ulnar nerve: an anatomic study. J Hand Surg Am. 1990;15A:603–7.
Cannon B, Chan L, Rowlinson JS, Baker M, Clancy M. Digital anaesthesia: one injection or two? Emerg Med J. 2010;27:533–6.
Tzeng YS, Chen SG. Tumescent technique in digits: a subcutaneous single-injection digital block. Am J Emerg Med. 2012;30:592–6.
Klein JA. The tumescent technique. Anesthesia and modified liposuction technique. Dermatol Clin. 1990;8:425–37.
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 (NY). 2007;2(1):5–11. doi:10.1007/s11552-006-9012-4.
Acknowledgments
We would like to express the deepest appreciation to Ankara Atatürk Training and Research Hospital Emergency Department physicians. Without their supervision and constant help this study would not have been possible.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Osman Mahir Okur, Alp Şener, Havva Şahin Kavaklı, Gülhan Kurtoğlu Çelik, Nurettin Özgür Doğan, Ferhat İçme and Gül Pamukçu Günaydın declare that they have no conflict of interest.
Ethical approval
All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Okur, O.M., Şener, A., Kavakli, H.Ş. et al. Two injection digital block versus single subcutaneous palmar injection block for finger lacerations. Eur J Trauma Emerg Surg 43, 863–868 (2017). https://doi.org/10.1007/s00068-016-0727-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-016-0727-9