From the Research
A great toe nerve block should be performed using 1-2 mL of 1% lidocaine with epinephrine on each side of the toe, as it provides a longer duration of anesthesia and is as safe as plain lidocaine in healthy adults. For this procedure, first, identify the web space between the first and second toes, then insert a 25-27 gauge needle perpendicular to the skin at the dorsal aspect of the web space and advance it to the plantar surface. After negative aspiration for blood, inject half the anesthetic while withdrawing the needle. Repeat on the medial aspect of the great toe to block the medial digital nerve. The block takes effect within 5-10 minutes and lasts 1-4 hours with lidocaine or 4-8 hours with bupivacaine. This technique works by blocking the terminal branches of the deep and superficial peroneal nerves dorsally and the medial plantar nerve on the plantar and medial aspects, effectively interrupting pain signals from the great toe. Some key points to consider when performing a great toe nerve block include:
- The use of epinephrine in digital nerve blocks has been shown to be safe and effective in adults, with a longer duration of anesthesia compared to plain lidocaine 1.
- The onset time of local anesthesia after single injection in toe nerve blocks can be affected by the type of local anesthetic used, with lidocaine having a faster onset time compared to bupivacaine 2.
- Ultrasound-guided popliteal nerve block with short-acting lidocaine has been shown to be effective in the surgical treatment of ingrown toenails, with a longer duration of sensory block and fewer repeat injections compared to digital nerve block 3.
- The choice of local anesthetic for digital nerve blocks depends on the procedure to be undertaken and the postoperative requirements, with lidocaine with epinephrine providing a good short-term anesthesia and bupivacaine with lidocaine providing good long-term anesthesia 4.
- Proper sterile technique and monitoring for rare complications such as vascular injection or allergic reactions are essential when performing a great toe nerve block. It is also important to note that peripheral nerve injury is a potential complication of local anesthetic injection, and the use of epinephrine may help to reduce the risk of this complication 5.