Chapter 55

### Digital Block

• • Provides analgesia in the fingers and toes for treatment of fractures, dislocations, and lacerations.

### Hematoma Block

• • Analgesia for fracture reduction.

• Most commonly used to reduce distal radius fractures or fractures of the fifth metacarpal (boxer’s fractures).

### Absolute

• • Skin or soft tissue infection at or near the area to be injected.

• Allergy to lidocaine or other agents used for regional anesthesia.

• • 5- or 10-mL syringe.

• 18-gauge needle to draw medicine; 25–27-gauge needle to inject medicine.

• Alcohol swabs to clean skin.

• 1% or 2% plain lidocaine (no epinephrine) or 0.25% bupivacaine (can be combined 1:1).

• Allergic reaction.

• • 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.

• • There are 2 dorsal nerves and 2 palmar/plantar nerves that innervate each digit; these are the proper digital nerves and they run with the proper digital arteries on the medial/lateral aspect of the digits.

### Digital Block

• • The needle is inserted 1–2 cm proximal to the webspace on 1 side of the digit (Figure 55–1).

• • 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 is sufficient.

• Massage the area to help spread the agent.

Digital block.

### Hematoma Block

• • Identify the fracture site and place the needle into the fracture site (dorsal approach for both distal radius and boxer’s fractures) (Figure 55–2).

• • Continue to aspirate until a flash of blood appears, redirecting the needle as necessary.

• After the flash of blood, slowly inject the lidocaine.

###### Figure 55–2.

Hematoma block.

• • Watch for vascular changes; vasospasm can occur but should resolve spontaneously.

• The ...

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

## Subscription Options

### AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.