Transthecal Digital Block: An Underutilized Technique In The ED

Transthecal Digital Block: An Underutilized Technique In The ED

ABSTRACTS The abstracts and commentaries in this issue were prepared by editorial board members of the Year Book of Emergency Medicine. These selecti...

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ABSTRACTS

The abstracts and commentaries in this issue were prepared by editorial board members of the Year Book of Emergency Medicine. These selections will appear in the 2007 volume. To order a copy of the entire 2007 Year Book of Emergency Medicine, call Mosby’s toll-free number 800-453-4351 or 314-453-4351 outside the United States. Commentaries appearing in Annals of Emergency Medicine may undergo additional editing by the Annals abstract editor. Reprints not available. Copyright © 2007 by Mosby, Inc.

Transthecal Digital Block: An Underutilized Technique In The ED Hart RG, Fernandas FAS, Kutz JE (Univ of Louisville School of Medicine, Ky; Christine M Kleinert Inst for Hand and Microsurgery, Louisville, Ky; Kleinert, Kutz Hand Care Ctr, Louisville, Ky) Am J Emerg Med. 2005;23:340-342 The transthecal digital block is a simple, safe, and effective anesthesia technique that can be used in many digital injuries. It is contraindicated only in cases of infection. The purposes of this article are to (1) discuss the indications for the transthecal digital block, (2) describe the technique, and (3) review the literature. The transthecal technique is used on appropriate patients almost to the exclusion of more traditional digital blocks by many hand surgeons. The advantages of this method are that it requires only a single injection, has a rapid onset of action, and requires only a small amount of anesthetic. It also has virtually no risk of direct mechanical trauma to the neurovascular bundles. This technique has been shown to be exceptionally effective. We encourage emergency physicians to use the transthecal technique when indicated. Comment: This article describes the transthecal digital block as an alternative to the traditional digital block. It is performed by a single injection into the flexor tendon sheath, which could be ideal

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in the pediatric population (or those adults behaving like kids). The onset of anesthesia is rapid with minimal to no risk of direct mechanical trauma. It could be used for lacerations, nail bed injuries, fingertip injuries, and foreign body removal; however, it is contraindicated in felons, tenosynovitis and any infectious process involving the flexor tendon. The transthecal digital block is most effective for the index, long, ring, and little finger thus providing anesthesia to the volar and dorsal surface. Of important note, volar anesthesia, without dorsal anesthesia, has been reported. The technique is as follows: a 1:1 mixture of marcaine and lidocaine without epinephrine in a syringe with a 25-30 Gauge needle is needed. Insert the needle at 90 degrees angle at the proximal digital crease that has been previously cleaned in usual fashion (see figure 1). Insert needle midline and away from any neurovascular bundles until the bone of the proximal phalanx is struck. Withdraw the needle about 2-3 mm, and redirect the needle to an angle of 45 degrees along the long axis of the digit (see figure 2). Inject slowly and no resistance should be felt (about 1.5-3 cc anesthetic). Onset of action is in 2-3 minutes on the average, and lasts about 6-8 hours. This transthecal digital block is worth learning and adding to your armamentarium. Eileen C. Quintana, MD, MPH doi:10.1016/j.annemergmed.2006.11.024

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118 Annals of Emergency Medicine

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