• 5- or 10-mL syringe.
• 18-gauge needle to draw medicine; 25–27-gauge needle to
• Alcohol swabs to clean skin.
• 1% or 2% plain lidocaine (no epinephrine) or
0.25% bupivacaine (can be combined 1:1).
• Complete and document a neurologic examination
before injecting the anesthetic.
• Do not use epinephrine in the digits because it can result in
ischemia, necrosis, and potential loss of the digit.
• The maximum lidocaine dose is 5 mg/kg (1% lidocaine has
10 mg/mL; 2% has 20 mg/mL).
• The maximum bupivacaine dose is 2 mg/kg.
• A lidocaine injection provides approximately 2 hours of pain
control, while a lidocaine/bupivacaine mixture (1:1) provides
approximately 5–7 hours of pain relief.
• For a digital block, pronate the patient’s
hand and place it on a flat surface.
• For the hematoma block, place the patient’s affected extremity
on a flat surface.
• It is advanced palmar/plantar to anesthetize
those digital nerves.
• Aspirate to be sure the needle is not intravascular.
• Inject the lidocaine as the needle is slowly pulled out dorsally.
• Repeat the procedure on the other side of the digit.
• This is not a large area; commonly 3–5 mL total of anesthetic
• Massage the area to help spread the agent.
• Continue to aspirate until a flash of blood appears,
redirecting the needle as necessary.
• After the flash of blood, slowly inject the lidocaine.
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