The authors compared traditional digital block anesthesia with single subcutaneous palmar injection block anesthesia in a randomized and controlled trial. There were no differences in time to anesthesia or injection site pain. A concurrent meta-analysis of published controlled trials revealed that palmar injection techniques carried a risk of not adequately anesthetizing the dorsum of the digit.
A palmar subcutaneous injection block theoretically avoids injury to the radial and ulnar digital nerves. The needle is directed mid-line, in between the neurovascular bundles. However, dorsal sensory nerve branches variably innervate the dorsum of the finger (Bas and Kleinert, JHS Am, 1999). If inadequate anesthesia is achieved with a palmar subcutaneous digital block, additional infiltration of anesthetic into the subcutaneous tissue at the dorsal base of the digit may provide benefit.
Digital, Block, Anesthesia
J Hand Surg