Finger Injuries: What is the Best Approach for Digital Block
Date First Published:
November 29, 2025
Last Updated:
November 29, 2025
Report by:
Kyle Lipa DO, Matthew Singh MD, Senior EM resident, EM faculty (Corewell Health/Michigan State University Emergency Medicine Residency Program)
Search checked by:
Jeffrey Jones MD, Research Director
Three-Part Question:
[In ED patients with a distal finger injury] is a [ring, dorsal block compared to flexor sheath block ] [more effective for local anesthesia]?
Clinical Scenario:
23-year-old otherwise healthy male presents to the ED for an injury to the distal portion of his right 3rd digit. He was working at a construction site when his finger got crushed between two large cement barriers. This resulted in a traumatic amputation of the distal tip of the digit. The distal tip is not salvageable. There is some exposed bone and not enough tissue to create a flap to close the wound. The wound is also grossly contaminated. You will need to thoroughly irrigate the wound and remove the bone down prior to closing the wound with a skin flap. You consider the most effective method of local anesthesia.
Search Strategy:
Medline 1966-10/25 using PubMed, Cochrane Library (2025), and Embase
Search Details:
[(Injections, Subcutaneous [MeSH]) AND (Nerve Block/methods [MAJR]) AND (Fingers [MeSH])].
Outcome:
16 articles were identified, three systematic reviews with meta-analysis addressed the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Comparison of traditional two-injection dorsal digital block versus transthecal and subcutaneous single-injection digital block: A systematic review and meta-analysis. Ito N, Umazume M, Ojima Y, et al. September 2021 Japan | Meta-analysis including 14 prospective randomized controlled studies and one prospective comparative study | Intervention with digital nerve block including traditional dorsal block, transthecal digital block, and palmar single injection digital block. | Time to onset of anesthesia, duration of anesthesia, injection pain, incomplete anesthesia and complications | The three methods of digital block showed similar onset times, durations, injection pain and incidence of incomplete anesthesia. This review confirmed that all three methods of digital block are equally effective. | Interrater reliability might be limiting as different physicians have different preference and experience with different techniques. The anesthetic and amount used differed between studies. Poor quality of the studies, unclear study designs, and biases were also limitations. |
| Digital nerve blocks: A systematic review and meta-analysis. Borbón TY, Qu P, Coleman-Satterfield TT, et al. July 2022 USA | Children and adult patients with distal finger injuries requiring repair and/or closure. | Meta-analysis using 23 individual RCTs or cohort studies comparing digital nerve block techniques. | Time to anesthesia (TTA), duration of anesthesia (DOA), and pain of injection. | Overall, mean TTA was 4.5 minutes (95% confidence interval [CI] 3.5, 5.6), mean DOA was 187 minutes (95% CI 104.3, 269.7), and mean pain score was 2.1 out of 10 (95% CI 1.3, 2.8) without significant differences between studies or techniques. | Participant measurements of anesthesia parameters and subjective reports of pain limited the generalizability of findings. In addition, this meta‐analysis did not evaluate the ease of administering each technique, the type, temperature, volume of the anesthetic used, or the use of epinephrine with anesthetics for digital nerve blocks. |
| Comparison of the effectiveness of local anesthesia for the digital block between single-volar subcutaneous and double-dorsal finger injections: a systematic review and meta-analysis of randomized control trials. Lee CH, Lin MH, Lin YT, et al. 2023 Feb-Dec Taiwan | Meta-analysis of 11 eligible RCTs (1363 patients) who required a digital nerve block. | The effectiveness of single-volar subcutaneous and double-dorsal injection was compared through a systematic review | Injection pain score, the onset of anesthesia, adjacent digit invalid numbness, dorsal proximal digit invalid anesthesia, distal phalanx invalid anesthesia, additional injection rate, patient preference, and adverse effects were extracted to evaluate discomfort during injections at different locations. | Single volar injection had a statistically significantly lower pain score (p=0.041) and higher patient preference but invalid anesthesia at the dorsal proximal digit. No significant differences were observed in the onset of anesthesia, adjacent digit invalid | The detailed procedure of the injection technique varied between studies. The patient sources varied among the studies, including volunteers, patients presented to the emergency department, and patients who went to surgery. The injection itself cannot be double-blinded. |
| numbness, distal phalanx invalid anesthesia, additional injection rate, and adverse effects. |
Author Commentary:
Digital blocks are an important skill of an ED physician, with finger injuries being a very common complaint. With studies showing there are no significant differences in anesthesia, one should select a technique that they are most comfortable with and become extremely proficient in performing it. By doing so, this can help to lower possible adverse effects such as poor anesthesia or damage to neurovascular structures.
Bottom Line:
Patients with finger injuries will achieve equal levels of anesthesia regardless of technique used, and physicians should use technique they are most proficient with to avoid damage to neurovascular structure and achieve highest level of anesthesia.
Level of Evidence:
Level 2: Studies considered were neither 1 or 3
References:
- Ito N, Umazume M, Ojima Y, et al.. Comparison of traditional two-injection dorsal digital block versus transthecal and subcutaneous single-injection digital block: A systematic review and meta-analysis.
- Borbón TY, Qu P, Coleman-Satterfield TT, et al.. Digital nerve blocks: A systematic review and meta-analysis.
- Lee CH, Lin MH, Lin YT, et al.. Comparison of the effectiveness of local anesthesia for the digital block between single-volar subcutaneous and double-dorsal finger injections: a systematic review and meta-analysis of randomized control trials.