Plastic Surgery Emergencies by Jamal M. Bullocks Patrick W. Hsu Shayan A. Izaddost

Author:Jamal M. Bullocks,Patrick W. Hsu,Shayan A. Izaddost
Language: eng
Format: epub
Publisher: Thieme Medical Publishing Inc.
Published: 2017-03-24T04:00:00+00:00

Digital Nerve Block

Two volar and two dorsal nerves innervate the digit. The common digital nerve and dorsal sensory nerves are blocked via a dorsal approach with one needlestick. Using a 25-gauge needle, a 1-mL wheal is made over the extensor mechanism at the level of the MCP joint to block the dorsal sensory nerve. The needle is then advanced volarly on either side of the joint in the web space until it is palpated in the palm. An additional 1 mL of local anesthetic is placed on each side to block the digital nerve.

Alternatively, a digital nerve block may be performed with direct instillation of the 1 to 3 mL of anesthetic agent in the adjacent web spaces dorsally and dorsal over the MCP joint (Fig. 13.1). Care must be taken not to perform circumferential instillation around the digit that may subsequently impair perfusion.

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