Provider Prepared's Weekly Pearl of Wound Wisdom #9 Give Pain the Finger!

A 30-year-old male presents to the emergency department with a laceration to his left index finger. This occurred when he inadvertently cut his finger with a knife while cutting through a cardboard box. He has fairly significant 10 out of 10 pain associated with this injury.

Digital nerve blocks are a very effective means of managing the pain associated with wounds and other finger injuries. Digital nerve block anesthesia not only allows management of pain but provides appropriate local anesthetic to proceed with procedures such as wound repair, reduction of dislocations and fractures, removal of fingernails, and repair of amputations.

An appropriate basic technique for performing a digital nerve block is to utilize a dorsal approach. Under sterile technique a 27 or 25-gauge needle is introduced just distal to the MCP joint at the base of the proximal phalanx, at the lateral edge of the bone. As the needle tip enters subdermal tissue a wheal of 0.5-1 mL of anesthetic without epinephrine is injected. This will block the dorsal digital nerve. The needle is then passed along the lateral edge of the bone toward the palmar surface, to the subdermal tissue of the palmar surface an additional wheal of 0.5-1.5 mL of anesthesetic is injected. This will block the palmar digital nerve. This procedure is then repeated on the opposite side of the digit to obtain a complete digital nerve block.

Roberts, JA et al. Clinical Procedures in Emergency Medicine 2010. 523, 526

After performing a digital block to the patient's left index finger using 2% lidocaine without epinephrine, he had complete relief of his pain. The wound was then explored extensively, there was no deep tissue injury and a single layer repair was performed using Prolene 5-0 suture material. Provider Prepared laceration repair kits come equipped with all the tools you need to perform appropriate wound care for all your finger injuries! Also available is lidocaine to perform digital nerve blocks. Click HERE to see our variety of laceration repair kits!

Provider Prepared

Nathan Whittaker, M.D.