Digital Nerve Block for 4th Digit Phalanx Surgery
For open reduction internal fixation and debridement of the 4th digit phalanx, you should perform a digital nerve block targeting the proper digital nerves on both sides of the 4th digit. 1, 2
Recommended Technique
A two-sided web space block (volar subcutaneous approach) is the preferred technique for the 4th digit, as it provides adequate anesthesia with a single injection per side and may be less painful than dorsal approaches. 1, 2
Technical Approach
Inject local anesthetic into the web spaces on either side of the 4th digit (between digits 3-4 and 4-5) to block the proper digital nerves supplying both sides of the digit 1, 2
Alternative dorsal approach: A traditional dorsal block or dorsal ring block can be used, though this requires two injections per digit and may cause more injection pain 1
Expected onset: Anesthesia typically occurs within 4.5 minutes (95% CI 3.5-5.6 minutes) regardless of technique 1
Duration: Expect approximately 187 minutes of anesthesia (95% CI 104.3-269.7 minutes) 1
Important Considerations
Coverage Limitations
Volar approaches provide excellent coverage of the digit but may have incomplete anesthesia of the proximal dorsal surface 1
If extensive dorsal dissection is planned proximally, consider adding a dorsal approach or supplementing with local infiltration 1
Anesthetic Selection
Lidocaine or bupivacaine are both appropriate choices for digital nerve blocks 1
Avoid epinephrine-containing solutions in digital blocks due to risk of digital ischemia (general medical knowledge)
Clinical Pitfall
The most common error is inadequate coverage of all four digital nerves (two proper digital nerves per digit). Ensure bilateral injection to achieve complete anesthesia of the entire digit for your surgical procedure. 1, 2