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Subject: Digital Nerve Block Anesthesia
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Syringes (3 or 5 mL), 2% lidocaine without epinephrine, and 25- or 27-gauge, 1.25-inch needles can be obtained from local surgical supply houses or pharmacies.
A suggested anesthesia tray that can be used for this procedure is listed in Appendix F.
Repair of digital lacerations
Nail procedures (e.g., ingrown nail surgery, nail bed biopsy, nail removal)
Incision and drainage of abscesses (e.g., felon surgery, paronychia surgery)
Anesthesia for fracture or dislocation manipulation of digital orthopedic injuries
Tumor or cyst removal or ablation (e.g., digital mucous cysts, giant cell tumors of sheaths, warts)
Use of epinephrine added to lidocaine, especially in patients with peripheral vascular disease.
Use of volumes >7 mL, especially in individuals with peripheral vascular disease, Raynaud disease or the phenomenon, digital vasculitis, or impaired circulation (e.g., diabetes, scleroderma).
PITFALL: The needle should be placed just below the dermis. Injecting the anesthetic into the dermis will not produce a satisfactory nerve block.
PITFALL: In large digits or digits that do not develop good anesthesia at the tip, insert the needle near the junction of the volar and lateral surfaces of the digit and inject additional lidocaine along the volar surface.
PITFALL: Do not attempt any assessment of anesthetic efficacy or the actual procedure until the block has had 5 minutes to work. Many novice and impatient physicians continue to add volume when a few more minutes of time would produce the desired effect, and the additional volume does not hasten the anesthesia.
Increasing rates of vascular compromise can be observed with circumferential infiltration, especially if volumes >7 to 8 mL are administered to the smaller digits. Use of 3- or 5-mL syringes can help avoid the temptation to deliver larger volumes.
Impaired digital circulation can also occur if an individual suffers from vasospastic disease such as the Raynaud phenomenon or if the digit is markedly swollen before infiltration.
Despite evidence for the safety of the practice, it is still advisable to avoid the addition of epinephrine to lidocaine for use on the digits.