Local Anesthesia vs. Digital Block For Finger Lacerations
Date First Published:
April 27, 2009
Last Updated:
May 20, 2009
Report by:
Omar M. Kolonda, Resident Physician (Grand Rapids Medical Education & Research/Michigan State University)
Search checked by:
Jeffrey S. Jones, MD, Grand Rapids Medical Education & Research/Michigan State University
Three-Part Question:
In [ED patients requiring anesthesia to the finger] is a [digital nerve block better than local anesthesia] at [minimizing pain during infiltration and achieving adequate anesthesia].
Clinical Scenario:
A 4 y/o boy presents to an urgent care setting with a 1 cm laceration across the volar aspect of his index finger just distal to the dip joint? The attending physician is debating whether to numb the laceration locally versus employing a digital block
Search Strategy:
Medline 1950-04/09 using OVID interface, Cochrane Library (2009), PubMed clinical queries
Search Details:
[(exp nerve block/ or "nerve block".mp or exp anesthesia or exp anesthesia, local) AND (exp metacarpus/ or "metacarpal".mp. or exp finger injuries/)]. LIMIT to human AND English.
Outcome:
96 papers were found of which 2 were relevant to the three part question
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Digital versus Local Anesthesia for Finger Lacerations: A Randomized Controlled Trial Chale S. Singer AJ. Marchini S. McBride MJ. Kennedy D 10-Jun USA | 55 patients presenting to a university-based ED > 8 y/o with finger lacerations. Pts were randomized to digital or local anesthesia w/LET. Pts were then assessed for quality of anesthesia s/p repair. | Single-center, prospective, randomized, clinical-trial design | Pain of needle insertion, anesthetic injection, and suturing. Secondary outcomes included patient satisfaction, time until anesthetic onset, and the presence of wound infection and persistent numbness. | Based on a validated visual analog scale, there was no between-group differences in pain of needle insertion, anesthetic infiltration, or suturing. | -Study size of 55 -Not double-blinded, practitioner and patient knew which arm of the study they were in. -No LET administered to digital block (even if it would provide a placebo effect) -VAS is a subjective form of data collection -1% Lidocaine was neither warmed, buffered, nor had any epi -Topical anesthesia for local group only administered for 15 mins -One study site |
| Suturing of digital lacerations: digital block or local infiltration? Robson AK. Bloom PA Nov-90 UK | 62 patients presenting to the Accident Department of the Bristol Royal Infirmary > 16 y/o w/finger lacerations not involving deep structures or under the influence of drugs/ETOH. Pts were randomized into a group receiving a digital block, the other local infiltration. Pts were then assessed for quality of anesthesia after repair was performed | A single-center, prospective, randomized trial | Primary outcomes included pain of administiring the anesthetic and pain of suturing posed to both physician and patient in the form of a questionaire | In each of the 4 q's posed by the questionairre, digital block was more effective than local infiltration | -study size of 62 -Not double-blinded, both practioner and patient knew which arm of the study they were in -only data presented is "p" values, so it is impossible to determine the clinical significance of the study -VAS used in questionnaire is a subjective form of data acquisition -2% lignocaine (lidocaine) was neither warmed, buffered, nor contained epi -One study site |
Author Commentary:
The UK study showed that the digital block was a more effective form of anesthesia based on responses from both the patient and the provider. The US study showed no difference in anesthesia between local infiltration and digital block with the only caveat being the administration of LET (lidocaine-epinephrine-tetracaine) in the local group. Digital block takes longer to take effect, but administering LET has the same effect. Unless staff applies LET in triage, there does not seem to be any significant advantage.
Bottom Line:
Until a clinical trial uses LET (lidocaine-epinephrine-tetracaine) in both arms, the effectiveness of analgesia cannot be accurately answered. Both methods are viable options in regards to efficacy and efficiency.
References:
- Chale S. Singer AJ. Marchini S. McBride MJ. Kennedy D. Digital versus Local Anesthesia for Finger Lacerations: A Randomized Controlled Trial
- Robson AK. Bloom PA. Suturing of digital lacerations: digital block or local infiltration?