Nerve block: digital block

Indications

• Need to anesthetize entire digit (finger or toe)
  • Laceration repair
  • Dislocation/fracture reduction
  • Pain control for traumatic injury
  • Paronychia
  • Felon
  • Nail trephination

Contraindications

• Overlying skin infection
• Distortion of landmarks

Equipment Needed

• PPE
• Local anesthetic
• 27-30ga needle
• Syringe
• Iodine or chlorhexadine prep

Maximum Doses of Anesthetic Agents

Agent	Without Epinephrine	With Epinephrine	Duration	Notes
Lidocaine	5 mg/kg (max 300mg)	7 mg/kg (max 500mg)	30-90 min	1% soln contains 10 mg/ml 2% soln contains 20 mg/ml
Mepivicaine	7 mg/kg	8 mg/kg
Bupivicaine	2.5 mg/kg (max 175mg)	3 mg/kg (max 225mg)	6-8 hr	0.5% soln contains 5 mg/ml May cause cardiac arrest if injected intravascularly Do not buffer with bicarbonate
Ropivacaine	3 mg/kg
Prilocaine	6 mg/kg
Tetracaine	1 mg/kg	1.5 mg/kg	3hrs (10hrs with epi)
Procaine	7 mg/kg	10 mg/kg	30min (90min with epi)

Complications

• Damage to surrounding structures
• Bleeding
• Infection
• Accidental intravascular injection of anesthetic