Two injection digital block versus single subcutaneous palmar injection block for finger lacerations

Okur, Osman Mahir; Şener, Alp; Kavakli, Havva Sahin; Çelik, Gülhan Kurtoğlu; Doğan, Nurettın Özgür; İçme, Ferhat; Günaydın, Gül Pamukçu

doi:10.1007/s00068-016-0727-9

Cited by 12 publications

(30 citation statements)

References 19 publications

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“…As the injections can be quite painful, different approaches have been investigated. One randomized controlled trial compared the efficacy of a single subcutaneous palmar injection (introduced vertically through the distal joint line of the metacarpophalangeal joint) versus the traditional 2 injection technique and found similar results in terms of pain control and time of anesthesia onset [33]. An observational case control study found that patients with a history of opioid abuse who underwent digital block required a higher total amount of local anesthetic, and the time to anesthesia onset was longer [34].…”

Section: Sedation and Analgesiamentioning

confidence: 99%

Updates in emergency department laceration management

Otterness

Singer

2019

Clin Exp Emerg Med

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Lacerations are a common reason for patients to seek medical attention, and are often acutely managed in the emergency department. Recent studies pertaining to closure techniques, sedation and analgesia, advances in wound care, and various other topics have been published, which may enhance our understanding of this injury and improve our management practices. This article will review pertinent studies published in the past few years relevant to laceration management. Understanding the current literature and appreciating which areas warrant further investigation will help us optimize outcomes for patients who sustain laceration injuries.

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Section: Sedation and Analgesiamentioning

confidence: 99%

Updates in emergency department laceration management

Otterness

Singer

2019

Clin Exp Emerg Med

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Section: Resultsmentioning

confidence: 99%

“…Fifteen studies included a dorsal approach in at least 1 of their injection groups: 2 studies used the DRB, 8 , 9 12 studies included the TDB, 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 1 study included the TDB+, 22 and 1 study included the MCB technique 10 . Eight studies used volar approaches to the digital nerve block: 6 included the TTB, 12 , 13 , 21 , 23 , 24 , 25 and 4 included the MTTB. 3 , 24 , 25 , 26 Thirteen studies included a single subcutaneous injection: 2 included the SIMPLE, 15 , 17 9 included the SCB, 16 , 18 , 19 , 20 , 24 , 25 , 27 , 28 , 29 and 1 included the SCB‐A1‐pulley.…”

Section: Resultsmentioning

confidence: 99%

“… 3 , 24 , 25 , 26 Thirteen studies included a single subcutaneous injection: 2 included the SIMPLE, 15 , 17 9 included the SCB, 16 , 18 , 19 , 20 , 24 , 25 , 27 , 28 , 29 and 1 included the SCB‐A1‐pulley. 23 Nine studies focused on only 1 digital nerve block technique, 3 , 8 , 9 , 11 , 22 , 26 , 27 , 28 , 29 12 studies compared 2 techniques, 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 23 and 2 studies compared 3 techniques. 24 , 25 …”

Section: Resultsmentioning

confidence: 99%

“…Twenty of the 23 studies included in our meta‐analysis used lidocaine 3 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 19 , 20 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 . Seven of these studies had at least 1 group that used lidocaine with epinephrine, 9 , 17 , 19 , 21 , 25 , 27 , 29 2 used buffered lidocaine, 10 , 12 1 used lidocaine in combination with topical lidocaine‐epinephrine‐tetracaine, 14 and 1 mixed lidocaine 1:1 with radio‐contrast. 25 Four studies used bupivacaine, 8 , 9 , 18 , 27 1 used bupivacaine mixed with lidocaine, 3 and 1 study used ropivacaine.…”

Section: Resultsmentioning

confidence: 99%

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Digital nerve blocks: A systematic review and meta‐analysis

Borbon

Coleman‐Satterfield

et al. 2022

JACEP Open

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Study objective Digital nerve blocks (DNBs) provide local anesthesia for minor procedures of the digits. Several DNB techniques have been described, but it is unclear which technique provides adequate anesthesia with the least pain. DNB techniques can be grouped into a dorsal approach, which requires 2 injections, versus 3 different types of volar approaches, which require a single injection. We performed a meta‐analysis to compare DNB techniques with respect to time to anesthesia (TTA), duration of anesthesia (DOA), and pain of injection. We also reviewed data on degree and distribution of anesthesia and discuss the techniques preferred by study participants and clinicians performing injections. Data Sources We searched MEDLINE, EMBASE, and CENTRAL databases with terms “digital block,” “digital nerve block,” “local anesthetic,” “local anesthesia,” “lidocaine,” and/or “bupivacaine.” Study Selection Randomized controlled trials (RCTs) were prioritized, though high‐quality prospective cohort studies were also eligible. All included studies evaluated DNB techniques or anesthetics. There were 23 papers (21 RCTs, 2 prospective descriptive studies) included. Data Extraction DNBs studied included dorsal ring block, traditional dorsal block, transthecal block, modified transthecal block, and volar subcutaneous digital blocks. Outcomes measured included TTA, DOA, pain of injection scores, and degree of anesthesia. Results Overall, mean TTA was 4.5 minutes (95% confidence interval [CI] 3.5, 5.6), mean DOA was 187 minutes (95% CI 104.3, 269.7), and mean pain score was 2.1 out of 10 (95% CI 1.3, 2.8) without significant differences between studies or techniques. Conclusions There were no significant differences in the outcomes of TTA, DOA, and pain of injection between different DNB techniques. Single‐injection volar approaches may be preferred by participants and clinicians over dorsal approaches that require 2 injections, particularly with respect to pain. However, 2‐injection dorsal approaches may have better coverage of the proximal dorsal surface based on degree and distribution of anesthesia.

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