Digital Nerve Block
Background
Digital nerve blocks are important tools for the emergency medicine clinician. Injuries or infections of
the digits are extremely common. Adequate analgesia is essential to properly address the presenting
condition and to minimize the patient's discomfort. Digital blocks are useful in many scenarios in
which local infiltration of an anesthetic would require several injections into the already painful site of
injury. Furthermore, local infiltration around the wound may create increased swelling, making the
repair more difficult. Several techniques are available for performing digital blocks.
Relevant anatomy
Each digit is innervated by 4 digital nerves. In the upper extremity, the digital nerves arise from the
median, ulnar, and radial nerves. The 2 palmar digital nerves innervate the palmar aspect of the digit
and the nail bed, whereas the dorsal nerves innervate the dorsum of the digit (see images below). The
tibial and peroneal nerves branch off into the digital nerves of the lower extremities, which follow a
pattern of distribution analogous to those of the upper extremity.[1]
Palmar digital nerves.
Dorsal digital nerves.
Indications
Digital blocks are indicated for any minor surgery or procedure of the digits. These include, but are not
limited to, the following:
Large irregular lacerations
Lacerations involving the nail or the nail bed
Ingrown nails
Felon or paronychia
Trephination of subungual hematoma
Digit dislocations or fractures[2]
Contraindication
Compromised digit circulation
Infected injection site
Known allergy to anesthetic
Best Practices
Avoid epinephrine use in the digits; a clamped Penrose drain can be used to limit bleeding.
Limit the patients discomfort by using a smaller needle, injecting slowly, and using small amounts of
anesthetics.
Anesthesia of the great toe is more difficult to achieve and requires 3-sided/4-sided ring blocks.
Use of sterile technique is essential to limit the risk of introducing infections (especially with the
transthecal block).
