Digital Nerve Block: Introduction

00:01 Hello, my name is Glenna Lashley and I am a family nurse practitioner.

00:06 Here at Lecturio, we realize that many students don't always get a chance to see or talk through advanced skills during the clinical rotations.

00:14 Today we're going to look at digital nerve blocks.

00:18 Digital nerve blocks are used for several reasons in the primary and acute care setting. Some examples are a digit could be dramatically jammed and need reducing.

00:29 There may be a significant hematoma that needs trephination, or there could be a finger or toenail that needs to be removed.

00:39 Depending on the specific reason for the block, there are different approaches to the anesthesia placement to choose.

00:46 The first is a traditional dorsal approach.

00:49 You're actually going to inject in the web spacing bilaterally on each side of the digit. The digital nerve at the dorsal lateral aspects is where you're actually going to inject. You're going to inject a volume of 1 to 1.5 cc per side.

01:09 The advantage of this is this is most familiar.

01:12 There's lower risk of neurovascular injury.

01:15 Some limitations are that this may require more volume and slower onset.

01:21 The image gives you where the nerve distribution is.

01:25 Then you can look at the digital angle as well as the dorsal, and then it also looks at the volar areas.

01:34 The second is a volar single subcutaneous approach.

01:38 The injection site is going to be a single midline injection at the digital crease.

01:45 Your target is the superficial to the flexor tendon sheath.

01:49 You're going to put 2 to 3 ccs of total volume.

01:54 Recent evidence suggests volar approaches provide fastest onset within 2 to 3 minutes versus 5 to 10. Single injection techniques reduce patient discomfort.

02:05 Similar efficacy rates between methods when properly performed, patients have higher satisfaction with volar techniques and increased provider comfort with dorsal approach.

02:19 The third most common is a transthecal approach.

02:22 Your injection site is going to be the midline volar at proximal digital crease.

02:28 The target is within the flexor tendon sheath.

02:31 You're going to use approximately two ccs of total volume.

02:35 Advantages of this is its rapid onset, complete anesthesia, but the limitations are risk of infection and flexor tenosynovitis.

02:46 As with any other procedure, there are supplies and steps you need to know.

02:50 I will talk you through the steps and show you the procedure itself.

02:54 As always, I will give you some insights along the way.

02:59 You want patient consent.

03:01 Before the procedure, explain that the injection of anesthesia is not painless, but the goal is to provide greater pain relief for the next part of the procedure. If other oral anxiety or pain medications are planned, make sure you obtain consent prior to the procedure being administered.