Comparison of the effectiveness of local anesthesia for the digital block between single-volar subcutaneous and double-dorsal finger injections: a systematic review and meta-analysis of randomized control trials

Lee, Che-Hsiung; Lin, Mo-Han; Lin, Yu‐Te; Hsu, Chung-Chen; Lin, Chih-Hung; Chen, Shih‐Heng; Huang, Ren-Wen

doi:10.1080/2000656x.2022.2070177

Cited by 1 publication

(2 citation statements)

References 39 publications

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“…The horseshoe sign is easy to recognize and confirms proper transthecal LA injection. As outlined by previous anatomical studies,15 the TT flexor sheath block allows the drug to reach the palmar and dorsal digital nerve branches, providing better anesthetic coverage when compared with the RB and the vsVS block 3 5. Further studies in the OR and ED settings are needed to understand if US use is safer for patients and can increase the quality of analgesia.…”

Section: Discussionmentioning

confidence: 97%

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Ultrasound-guided flexor sheath block as a valid alternative to blind techniques for finger pain treatment: the horseshoe sign

Fioccola

Skerritt

2023

Reg Anesth Pain Med

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BackgroundThe flexor sheath digital block allows effective analgesia and anesthesia for finger pain control. To date, only blind techniques are described in the literature in patients with finger fractures, supposedly due to the superficial position of the structures used as landmarks. We describe an ultrasound-guided technique with a definite endpoint to achieve this block. To our knowledge, this is the first clinical application of this procedure.MethodsWe performed a preoperative ultrasound-guided flexor sheath digital block on a young patient with a proximal phalanx fracture, undergoing an osteotomy with plate placement. After performing the block, opioid-free general anesthesia was performed. A “hockey-stick” ultrasound probe and 1.5 mL of 0.5% levobupivacaine were used to infiltrate the flexor sheath. The “horseshoe sign” was our visual endpoint for successful block performance.ResultsAt the time of surgical incision, there was no hemodynamic response. No opioids were administered during the case or in the recovery room, and the patient’s pain scores in recovery and at discharge were 0/10 on the Numerical Rating Scale. No complications were observed or reported.ConclusionsThe ultrasound-guided flexor digital sheath block is a valid alternative to the blind technique, allowing direct visualization and, thereby, confirming transthecal injection of the local anesthetic. The continuously increasing availability of ultrasound machines in emergency departments and operating theaters may encourage the spread of this technique.

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Section: Discussionmentioning

confidence: 97%

“…First, the necessity of multiple injections. Second, the limited efficacy of the two-injection approach to cover the distal part of the finger/nail bed 3–5. Lastly, it carries a theoretical risk of damage to the neurovascular finger bundle6 7 and may result in compartment syndrome 8…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided flexor sheath block as a valid alternative to blind techniques for finger pain treatment: the horseshoe sign

Fioccola

Skerritt

2023

Reg Anesth Pain Med

View full text Add to dashboard Cite

show abstract

Comparison of the effectiveness of local anesthesia for the digital block between single-volar subcutaneous and double-dorsal finger injections: a systematic review and meta-analysis of randomized control trials

Cited by 1 publication

References 39 publications

Ultrasound-guided flexor sheath block as a valid alternative to blind techniques for finger pain treatment: the horseshoe sign

Ultrasound-guided flexor sheath block as a valid alternative to blind techniques for finger pain treatment: the horseshoe sign

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