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Level of blockadeCoverage distribution
Digital nerves at base of proximal phalanxFinger
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Anatomy:

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The common digital nerves are branches of the median and ulnar nerves.

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The main digital nerves, accompanied by digital vessels, run on the ventrolateral aspect of the finger immediately lateral to the flexor tendon sheath. Small dorsal digital nerves run on the dorsolateral aspect of the finger and supply innervation to the back of the fingers as far as the PIP joint.

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Indications:

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Small procedures on the finger.

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Contraindications:

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Do not use epinephrine-containing local anesthetic.

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Technique (Figures 138-1 to 138-2):

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Figure 138-1. Angle and Depth of Needle Insertion
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Reproduced from Hadzic A. The New York School of Regional Anesthesia Textbook of Regional Anesthesia and Acute Pain Management. Figure 30-3. Available at: www.accessanesthesiology.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.

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Figure 138-2. Needle Insertion at the Base of the Proximal Phalanx to Block the Medial Digital Nerve
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(A) Dorsal view. Reproduced from Hadzic A. The New York School of Regional Anesthesia Textbook of Regional Anesthesia and Acute Pain Management. Figure 30-4. Available at: www.accessanesthesiology.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved. (B) Palmar view. Advancement of the needle is stopped when the needle tip causes a skin bulge on the palmar side. Reproduced from Hadzic A. The New York School of Regional Anesthesia Textbook of Regional Anesthesia and Acute Pain Management. Figure 30-5. Available at: www.accessanesthesiology.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.

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A 25G 1.5 in. needle is inserted at the base of the finger on the dorsolateral aspect, and directed anteriorly toward the base of the phalanx. The needle is advanced adjacent to the phalanx bone, while the operator observes the palmar skin for a protrusion due to the needle. After aspiration, 2–3 mL of local anesthetic is injected, and 2 more mL is injected continuously as the needle is withdrawn back to the skin. The same procedure is repeated on the other side of the finger.

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Testing:

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No motor block is achieved.

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Sensory block of the finger can be tested by pinching or pinprick.

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Complications/side effects:

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Avoid finger tourniquet. Do not use epinephrine-containing local anesthetic: risk of ischemia.

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Another technique is the transthecal block, where 2–3 mL of local anesthetic is injected into the flexor sheath. Success rate is reportedly ...

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