Abstract
Background
There is level II evidence that volunteers prefer the single subcutaneous injection in the midline of the proximal phalanx with lidocaine and epinephrine (SIMPLE) finger block over the classic two dorsal injection block technique. The purpose of this study was to possibly further decrease the pain of digital block injection by examining the effect of the duration of injection on the pain felt by volunteers receiving the SIMPLE block at two different injection rates.
Methods
Forty healthy blinded volunteers were injected 2 mL of lidocaine 1 % and epinephrine 1/100,000 in the digital palmar crease of both long fingers, one at a time. Two different rates of injection were used: 8 and 60 s. Pain scores were measured using a visual analogue scale and the volunteers were asked which of injection techniques they preferred.
Results
The visual analogue scale results revealed less pain with the slow injection (p < 0.001). Thirty three out of 40 volunteers preferred the slow injection rate. No difference could be attributed to sex of participants or to the first hand injected.
Conclusion
Blinded volunteers preferred digital blocks injected over 60 s to the more rapid 8 s. Decreasing the pain of injection only takes a minute of our valuable time for finger blocks.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Braun H, Harris ML. Operation on the extremities. In Local anesthesia: its scientific basis and practical use, 2nd American edition from the 6th revised German edition. Philadelphia: Lea and Febiger; 1914. p. 367.
Brutus JP, Baeten Y, Chahidi N, et al. Single injection digital block: comparison between three techniques. Chir Main. 2002;21(3):182–7.
Cepeda MS, Tzortzopoulou A, Thackrey M, et al. Adjusting the pH of lidocaine for reducing pain on injection. Cochrane Database of Systematic Reviews 2010;8(12): Art. No.: CD006581.
Cummings AJ, Tisol WB, Meyer LE. Modified transthecal digital block versus traditional digital block for anesthesia of the finger. J Hand Surg Am. 2004;29(1):44–8.
Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg. 2001;108(1):114–24.
Fitzcharles-Bowe C, Denkler KA, Lalonde DH. Finger injection with high-dose (1:1000) epinephrine: does it cause finger necrosis and should it be treated? Hand. 2007;2:5–11.
Hogan ME, Vaart S, Perampaladas K, et al. Systematic review and meta-analysis of the effect of warming local anesthetics on injection pain. Ann Emerg Med. 2011;8(1):86–98.
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(6):581–4.
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(5):1131–4.
Krause RS, Moscati R, Filice M, et al. The effect of injection speed on the pain of lidocaine infiltration. Acad Emerg Med. 1997;4(11):1032–5.
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(5):1061–7.
Low CK, Vartany A, Engstrom JW, et al. Comparison of transthecal and subcutaneous single-injection digital block techniques. J Hand Surg Am. 1997;22(5):901–5.
Low CK, Wong HP, Low YP. Comparison between transthecal and subcutaneous digital blocks. J Hand Surg Br. 1997;22(5):582–4.
Martires K, Malbasa CL, Bordeaux JS. A randomized controlled crossover trial: lidocaine injected at a 90-degree angle causes less pain than lidocaine injected at a 45-degree angle. J Amer Acad Derm. 2011;65(6):1231–3.
Nodwell T, Lalonde DH. How long does it take phentolamine to reverse adrenaline-induced vasoconstriction in the finger and hand? A prospective randomized blinded study: the Dalhousie project experimental phase. Can J Plast Surg. 2003;11:187.
Thomson CJ, Lalonde DH, Denkler KA, et al. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg. 2007;119:260–6.
Wheelock ME, LeBlanc M, Chung B, et al. Is it true that injecting palmar finger skin hurts more than dorsal skin? New level 1 evidence. Hand. 2011;6:47–9.
Whitworth JM, Kanaa MD, Corbett IP, et al. Influence of injection speed on the effectiveness of incisive/mental nerve block: a randomized, controlled, double-blind study in adult volunteers. J Endod. 2007;33(10):1149–54.
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(5):1195–200.
Yin ZG, Zhang JB, Kan SL, et al. 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.
Conflict of interest
The authors declare that they have no conflicts of interest, commercial associations, or intent of financial gain regarding this research.
Author information
Authors and Affiliations
Corresponding author
Additional information
This project was not supported by any grant.
About this article
Cite this article
Hamelin, N.D., St-Amand, H., Lalonde, D.H. et al. Decreasing the pain of finger block injection: level II evidence. HAND 8, 67–70 (2013). https://doi.org/10.1007/s11552-012-9478-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11552-012-9478-1