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HOW TO PERFORM A DIGITAL (FINGER) BLOCK

Hey Preppers, Emergency room physicians in busy medical centers see and treat a lot of finger injuries each week. From lacerations (cuts) to f ractures, it is of ten dif f icult to f ully evaluate and treat (suturing a cut or straightening a broken or displaced f inger bone) without numbing the area. Even cleaning blood or debris f rom an injury may be painf ul enough to require anesthesia. Anesthetic creams would probably not be suf f icient to provide pain relief . Local injectables such as Lidocaine (brand name Xylocaine), are necessary to provide anesthesia. Lidocaine may be placed around the actual wound superf icially (local inf iltration) or may be directed to block a specif ic nerve that serves the area to be treated. T his procedure is known as a nerve block.

How Nerve Blocks are Used

Each nerve block is intended to numb a portion of the course of a nerve as it travels through the body, so as to numb the injured area. For a f inger injury, numbing the entire f inger gives superior anesthesia to just placing some Lidocaine around the injury itself (in most cases). T here are various injectable local anesthetics on the market, such as Procaine (Novocain), Bupivacaine (Marcaine), and Mepivacaine (Carbocaine). Lidocaine (Xylocaine) is, however, the most widely used these days, due to the rapidity and ef f ectiveness of its anesthetic action. 1% or 2% plain Lidocaine is acceptable; f or areas like f ingers, which have limited circulation, avoid Lidocaine with Epinephrine . Epinephrine constricts the blood vessels and may compromise blood f low, and even lead to gangrene and the loss of the digit. Bef ore you consider the use of local anesthetic, you should be aware of your patients medical history. Some, such as those with liver disease, cardiac disease, or the elderly, should receive less quantities of the drug. Veterinary Lidocaine is not exactly the same as human Lidocaine, by the way. T here are several ingredients in veterinary Lidocaine that are called inert that cost money to remove, and have been extracted f rom human Lidocaine.

The Anat omy of a Finger

T he anatomy of a f inger includes bone, tendons, nerves, and blood vessels. For our purposes today, lets look at the nerve distribution of the distal hand and f ingers. T he median and ulnar nerves travel up opposite sides of the wrist and branch out into digital nerves. T hese run up opposite sides of the palmar aspect of the f inger, and branch again to give sensation to the back of the f ingers as well.

Source of image: www.nysora.com Of course, youll need some equipment: Sterile towels and gauze to create a sterile f ield in which to work,an antiseptic such as Betadine , at least one 6cc or 10cc syringe, and a thin gauge 1-1 inch needle (25 or 27 gauge will do f ine). Dont f orget gloves! You can decrease the sting of the injection by warming the local anesthetic somewhat and/or adding 1cc of sodium bicarbonate solution to 10cc of medication. T he procedure to give anesthesia to a f inger is relatively simple. Despite this, the f ollowing inf ormation is f or your inf ormation and possible use only in a post-apocalyptic situation where modern medical care is inaccessible f or the f oreseeable f uture. If there are doctors with experience in this procedure, seek them out. Place the hand pronated on the sterile f ield (use more Betadine than I did in the photos). With your small gauge needle and a Lidocaine syringe, place a small amount of local anesthesia on either side of the base of the f inger, raising a wheal (a slight swelling) just under the skin. T his will make any later injections less painf ul. Af ter waiting a minute or so, insert the needle in the wheal and f orward toward the base of the f inger bone. Begin injecting the local anesthesia. Repeat on each side of the injured f inger. 1-2 ml, injected as you slowly withdraw the needle, on each side should be suf f icient. Too much may cause compression of blood vessels. An alternative to this approach, or perhaps an addition f or more complete anesthesia, is the transthecal f inger block. T he benef it is that this approach may numb the f inger with a single injection, if done correctly. To perf orm this type of block, turn the hand palm up, and f ollow the tendon of the f inger down to the level of the f irst palmar crease line. Inserting the needle at a 45 degree angle, go down to the tendon and inject 2 ml of Lidocaine. If you notice resistance you are too close to the tendon and should pull back a little. Some suggest rubbing the area to distribute the medication.

Wait about 10 minutes or so bef ore assessing f or completeness of anesthesia. T his may be done by lightly pricking with a saf ety pin or applying slight pressure to the area. Af ter any work on the f inger injury, immobilize it with a f inger splint or the buddy method of using an adjacent f inger f or support. Cover with a generous wrapping. Some important things to know: Dont inject any area that is clearly inf ected (red, swollen, warm to the touch) Use small gauge needles to avoid hitting blood vessels and causing bleeding Dont inject into any visible veins Pull back on the needle bef ore you inject anesthesia; if you see blood in the syringe, abort and try again Avoid Epinephrine No more than 2 ml on each side of the f inger If the injection is extremely painf ul, you may be hitting the nerve with the needle; abort and try again T here is always more to know about medical procedures that what can be written in one article. Do your own research, and come to your own conclusions as to whether you should consider learning this type of medical technique. Dr. Bones