11. Digital Block Flashcards
volar
palm side
anterior
dorsal
back on hand
posterior
median hand (anterior/posterio)
ulnar
C8-T1
posterior lateral hand
radial
C5-C6
anterior lateral hand
fingertips of first 3.5 digits
median
C6-C8
digital block indications
finger or toe surgery
ring block insertion
dorsolateral aspect of base of finger
ring block needle advance
until it contacts bone (phalanx)
ring block volume
< 2 mL on each side
-1 mL as withdrawing first 1-2 mm after bone contact
- 1 mL as withdrawing to skin
TOTAL ring block volume
< 4 mL per digit
transthecal block needle insertion
45 degree angle
distal to palmart crease
where is LA injected into for transthecal block
flexor tendon sheath
transthecal block volume
2-3 mL
resistance during transthecal block indicates
needle tip contacting tendon
transthecal advantage
single injection
which is more painful ring block or transthecal block?
transthecal block
subQ volar digital block needle injection
pinch skin on volar side of finger
insert perpendicular
subQ volar block volume
2 mL
easiest digital block
subQ volar
least painful digital block
subQ volar
which digital block require proximal pressure?
transthecal
subQ volar
why is proximal pressure applied?
to ensure more distal spread of local
transthecal onset
faster
120 sec
transthecal duration
shorter
3 hrs
transthecal pain
painful
3.1
subQ volar onset
slower
140 sec
subQ volar duration
longer
4.3 hrs
subQ volar pain
not as bad
2.4
which digital block do pts prefer?
subQ volar
3 sided big toe block how many injections
3
what injections does the big toe block get?
medial
dorsal
lateral
big toe block medial insertion
perpendicular
which toes can the 3 sided block be used for?
all of them
toe block volume: big toe
4-6 mL
toe block volume: small toes
3 mL
digital block complications
hematoma
compartment syndrome
great toe block volume
<6 mL
finger and small toe block volume
< 4 mL
tranthecal and subQ block volume
< 2 mL
digital block CI
epi
pts w/compromised digital circulation
pts w/compromised digital circulation
diabetes
peripheral vascular disease
raynauds
AV fistula
digital block advantages
easier
not as painful
lower risk of LAST
digital block disadvantages
multiple injections
shorter duration