Strauss1 provided the first description of the
digital block in 1889 for the condition of an ingrown toenail, using 20% cocaine at the base and under the nail. In 1905, Braun reported the
synergistic advantage of adding epinephrine to local
anesthetics.2,3 However, the use of epinephrine in digital
block anesthesia has been avoided due to the theoretical risk of ischemia
and possible gangrene. More recently, however, Wilhelmi and
colleagues4 demonstrated the safety and efficacy of
epinephrine-containing local anesthetic for digital block, which made its
use only more controversial. Digital block is one of the most common nerve
block techniques, frequently used in the emergency department and primary
care settings for various procedures such as lacerations of the finger or
toe, nail removal, nail bed repair, paronychia drainage, removal of foreign
bodies, and any other painful procedures on digits.