Single injection digital block: comparison between three techniques

• Published in: Chirurgie de la main 2002, Vol.21 (3), p.182-187
• Main Authors: Brutus, J.P., Baeten, Y., Chahidi, N., Kinnen, L., Ledoux, P., Moermans, J.P.
• Format: Article
• Language: English
• Subjects: Anesthesia; Anesthesia, Conduction - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - administration & dosage; Anesthetics, Local - pharmacology; anesthésie locale; Biological and medical sciences; bloc digital; digital block; Fingers - innervation; Humans; injection unique; Injections, Subcutaneous; local anesthesia; Local anesthesia. Pain (treatment); Medical sciences; Nerve Block - methods; Pain Measurement; Patient Satisfaction; Prilocaine - administration & dosage; Prilocaine - pharmacology; single injection; sous cutané; subcutaneous; transthecal; transthécal
• ISSN: 1297-3203; 1769-6666
• DOI: 10.1016/S1297-3203(02)00107-5

Introduction – Regional anesthesia of a single finger is commonly achieved by the traditional ring block. The major drawback of this technique is the need for at least two painful injections in the digit. Single injection techniques have been described. A comparison of their results could help health professionals select the most appropriate technique. Material and methods – A prospective randomized study was designed to compare three techniques in term of patient tolerance, distribution of anesthesia and efficiency: the modified transthecal digital block, the subcutaneous digital block and a combination of the two. Digits were randomized in three groups ( n=30). Blocks were performed by a single investigator. A visual analogic scale was used to evaluate pain associated with the injection. Prick-testing was used to evaluate anesthesia at the volar and dorsal aspects of the phalanxes. Statistical analysis of the results was performed. Results – All techniques allowed surgery to be performed without complementary injection most of the time (25/30). The dorsum of the proximal phalanx, however, was unpredictably included in the anesthetized territory. The highest rate of full digital block was achieved with the combined technique. Discussion – The least invasive of equally effective techniques should be considered as the first choice. The subcutaneous single injection digital block is safe, efficient and easy to perform. It allows treatment of all conditions on the volar aspect of the finger and on the dorsal aspect of the distal and middle phalanxes. For surgery on the dorsal aspect of the proximal phalanx, a supplementary dorsal block should be used. Introduction – L'anesthésie d'un doigt est le plus souvent réalisée par le bloc digital « en bague », lequel requiert au moins deux injections douloureuses à la base du doigt. Des techniques à injection unique ont été décrites. Une comparaison de celles-ci pourrait aider à choisir la technique la plus appropriée. Matériel et méthodes – Une étude prospective randomisée a permis la comparaison de trois techniques en termes de tolérance à l'injection, de distribution de l'anesthésie et d'efficacité : le bloc transthécal modifié, le bloc sous cutané et le bloc combiné. Les doigts ont étés répartis de façon aléatoire en trois groupes (n=30). Une échelle visuelle analogique a permis l'évaluation de la douleur associée à l'injection. Le test à la piqûre a permis d'évaluer l'obtention de l'anesthésie aux faces palmaire