Clinical experiences and dosage pattern in subcutaneous single-injection digital block technique

Abstract

100 patients with injuries to their fingers were treated using the subcutaneous digital block as described by Low et al.. Different dosages ranging from 2 to 3 millilitres of a local anesthetic were required to obtain appropriate anesthesia according to the location of injury. 108 finger injuries were treated, 18 thumb injuries, 90 finger injuries. The anesthetic was administered using a 0.55 x 25 mm needle and injected strictly subcutaneously into the flexor crease at the base of the finger or thumb. Injuries to the palmar aspect of the fingers were anesthetized using 2 ml of a local anesthetic (1% Lidocain), whereas 3 ml were needed for sufficient pain relief in case of injury to the dorsal aspect of the fingers. Injury to the thumb required a higher dosage (3 ml subcutaneously), and only offered sufficient pain relief for palmar injuries. In the case of dorsal injuries, we found that this technique was not sufficient in providing pain relief. Additionally, we performed a deep local nerve block (Oberst), if the patient still felt discomfort or pain. The severity or type of injury did not play a role according to our findings. The subcutaneous finger block as described by Low et al., therefore, is the method of choice treating injuries to the fingers and to the palmar aspect of the thumb, since it offers a decrease in the amount of anesthetic required and increases patient comfort.