Can a digital nerve block be performed on a finger with a felon (infection of the fingertip)?

A digital block should not be performed on a finger with a felon (a painful infection of the pulp space of the fingertip). This is because a digital block involves injecting anesthetic around the base of the finger, which could potentially spread the infection by increasing pressure within the already confined space or by introducing the needle through infected tissue. Instead, the recommended approach for anesthetizing a felon is a landmark-guided or ultrasound-guided flexor tendon sheath block at the level of the palm, which avoids the infected area. Alternatively, procedural sedation or a more proximal nerve block may be considered. The concern with digital blocks in felons stems from the anatomy of the fingertip, which contains multiple small compartments separated by fibrous septa. Infection in these spaces creates significant pressure and pain, and any procedure that might increase this pressure or spread the infection could worsen the condition or delay healing. The definitive treatment for a felon typically involves incision and drainage under appropriate anesthesia, along with antibiotics to address the underlying infection.