Mod 5: Hallux Digital blocks, Lesser digital blocks, and LA infiltration

Question 1

How many nerves is each digit supplied by?

Answer 1

Four. 2 dorsal, 2 plantar running on the medial and lateral aspects of the digit

Question 2

Sensation to the dorsal aspect of the Hallux is provided by?

Answer 2

Medial:Medial dorsal digital nerve from medial cutaneous nerve of Superficial Peroneal.
Lateral:Lateral dorsal digital nerve from medial terminal branch of Deep Peroneal.

Question 3

Sensation to the plantar aspect of the Hallux is provided by?

Answer 3

Medial:1st proper planter digital nerve of Medial Plantar nerve.
Lateral: Terminal branch of 1st common digital nerve from Medial Plantar Nerve.

Question 4

At the level of the proximal phalanx base, the dorsal digital arteries,veins, and nerves are larger or smaller than their plantar counterparts?

Answer 4

Smaller.

Question 5

What is the usual volume of LA required for Hallux block?

Answer 5

3-5ml of 1% Xylocaine per Hallux

Question 6

What is the the dose required for Hallux block?

Answer 6

30-50mg of Xylocaine per Hallux

Question 7

What are the most suitable syringes for Hallux block?

Answer 7

1 x 5cc or 2 x 3cc

Question 8

What is the most suitable needle for Hallux block?

Answer 8

25-30 gauge 1 and half inch needle

Question 9

What is the most suitable needle for drawing up LA solution?

Answer 9

18-21 gauge needle 1 inch

Question 10

There are 2 techniques to block digits, these are?

Answer 10

2 point Hallux ring block

2 point Hallux block

Question 11

When documenting the Injection it is important to state what?

Answer 11

1. Injection site and technique (block type)
2. Quantity, %, type of drug administered
3. Effectiveness of block achieved
4. Lack of presenting adverse reactions
5. Signature.

Question 12

LA infiltration is not a block of a specific nerve but rather….

Answer 12

…a block of a specific infiltrated area independent of nerve sensory dermatomes and neurotomes.

Question 13

When is LA infiltration useful?

Answer 13

1. Anesthetizing areas difficult to block by regional or specific nerve block.
2. For procedures limited to well defined area of the skin or subcutaneous tissue

Question 14

Name the 2 typre of infiltration.

Answer 14

Deep Infitration (sub q tissues)
Superficial Infiltration (dermal tissues)

Question 15

What are the characteristics of Deep Infiltration (Sub q)?

Answer 15

1. May/may not produce wheal
2. Can be used for Punch, Incisional, and Excisional biopsies
3. Less painful than dermal infiltration
4. May take up to 10 mins to work

Question 16

What are the characteristics of Dermal Infiltration?

Answer 16

1. Produces a wheal
2. Can be used for shave biopsy of in prep for larger needle
3. rapid onset
4. More painful than deep infiltration

Question 17

Name the 3 LA infiltration techniques.

Answer 17

1. Raising a wheal
2. Diamond Block
3. Proximal ‘V’ Block

Question 18

What are the 6 general rules of LA Infiltration?

Answer 18

1. Do not inject directly into a lesion
2. Anatomical landmarks should be palpated, Identified and marked (if desired) PRIOR.
3. NV structures should be palpated, identified, and marked PRIOR
4. Borders and margins of the lesion should be marked PRIOR
5. Skin quality and integrity should be evaluated before deciding on infiltration technique, poor quality may require nerve/regional block
6. Do not inject directly into marked area to avoid tattoo effect