EMed

Digital nerve (ring) block

Background

  • Used for digit anaesthesia
  • Consider if a more proximal regional block may be more appropriate

Equipment:

  • Something to clean the skin
  • 1% lignocaine (or preferably 0.5% Bupivacaine - longer duration ) in a syringe, with a 25G or "diabetic" needle for skin infiltration

LA toxicity

  • The toxic dose for Lignocaine is 3 mgs per kilo or 20 mls of 1% Lignocaine for an adult
  • In a child = 1 ml of 1% plain Lignocaine for each year of the child's age
  • Before any regional anaesthesia ensure you are familiar with the signs / management of LA Toxicty

Procedure

  • 3mls of 0.5 % Marcaine in preference to 1% plain lignocaine [Bestbets]
  • Use either a single injection (3ml) at the base of the finger (MCPJ palmer crease) (Cannon B. EMJ 2010) or two injections with a dorsal approach
  • Usually takes approx. 5 minutes before adequate analgesia is achieved
  • Digital nerve block is better than metacarpal block [Bestbets]
DNB - Volar Approach

Content by Dr Íomhar O' Sullivan 26/12/2018. Last review Dr ÍOS 21/06/21.