Digital Nerve Blocks: A Comprehensive Review of Techniques.

BACKGROUND: Finger and toe injuries are a common reason for presentation to the emergency department. In order to properly care for these injuries, it is valuable for emergency medicine clinicians to be aware of the different approaches to anesthetize the digit. METHODS: We searched the literature using PubMed to determine the different techniques and supporting data for digital nerve blockades. DISCUSSION: The primary digital nerve block techniques include the dorsal web space block, transthecal block, volar subcutaneous block, and the circumferential (three-sided and four-sided) ring block. Success rates range from 60% to 100%. There are unique advantages and limitations of each block that are important to consider. CONCLUSIONS: There are a number of options at the disposal of the emergency medicine clinician for anesthesia of the finger and toe. This article summarizes the key techniques, variations on these techniques, advantages, and disadvantages for each approach.

Comparison of Transthecal Approach With Traditional Conservative Approach for Primary Closure After Incidental Durotomy in Anterior Lumbar Tear.

BACKGROUND: Incidental durotomies (IDs) are frequent complications of spinal surgeries which are mostly posterior or lateral. Anterior IDs are rare; however, they may lead to severe complications. We compared the transthecal approach with the conservative approach for primary closure after durotomy in anterior lumbar dural tear to assess the efficacy of these approaches to decrease postsurgical complications and clinical outcomes. METHODS: A total of 21 patients undergoing L2-S1 laminectomy with anterior ID were randomly divided into a transthecal group (n = 9) and a conservative group (n = 12) based on the surgical dural closure technique. Postoperative pseudomeningocele, wound infection, rootlet herniation, pneumocephalus, cerebrospinal fluid (CSF) leakage, headache, meningitis, in addition to surgery duration and length of hospitalization were examined and compared in both groups. RESULTS: The frequency of pseudomeningocele and CSF leakage in patients undergoing the transthecal approach was significantly lower than those undergoing the conservative approach (P = .045 and .008, respectively). Furthermore, although the differences in the frequency of meningitis, pneumocephalus, headache, and wound infection were not statistically significant between the 2 groups, the effect sizes of the comparison were obtained as 49.4, 19.8, 7.1, and 2.6, respectively. This indicated that the differences were clinically significant between the 2 groups. CONCLUSIONS: We found that the transthecal approach was significantly more successful in managing CSF leakage as well as its complications and clinical outcomes. However, further clinical trials with bigger sample sizes are needed to substantiate this claim.

Comparison of traditional two-injection dorsal digital block versus transthecal and subcutaneous single-injection digital block: A systematic review and meta-analysis.

Digital nerve block is a common procedure with several techniques, including the traditional digital nerve block, transthecal digital nerve block, and single subcutaneous palmar digital nerve block. This review aimed to evaluate the efficacy of these three methods. A systematic search was performed in the PubMed, Scopus, and Cochrane Library databases. The risk of bias of the studies was assessed using the Cochrane Collaboration's tool for assessing the risk of bias and the Risk of Bias Assessment Tool for Non-Randomized Studies. Fourteen prospective randomized controlled studies and one prospective comparative study were included. 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. Considering that patients prefer a single injection and the potential risk of complications, the single subcutaneous digital block could be more widely used.

Clinical application of modified transthecal digital block in treatment of hand trauma in children / 吉林大学学报(医学版)

Objective: To probe the advantages and clinical application value of modified transthecal digital block in the treatment of hand trauma in the children, and to provide the references for the selection of anesthesia methods for surgery. Methods: A total of 102 patients (104 digits) required acute or chronic hand surgery were selected. The patients were divided into two groups by the method of random number table, 54 patients (54 fingers) were treated with traditional digital block (traditional digital block group), and 48 patients (50 fingers) were anesthetized with modified transthecal digital block (modified transthecal digital block group). The pain detection was performed on the 4 sites within 5 min after anesthesia by using the method of Face, Legs, Activity, Cry, Consolability Behavioral Tool (FLACC) ( 0. 05). Compared with traditional digital block group, the average onset time of anesthetic drug of the patients in modified transthecal digital block group was shortened (P<0.05), and the average dose of anesthetic drug was decreased (P<0. 05). Conclusion: The modified transthecal digital block has the advantages of smaller dose, quicker effect, easier operation, and less pain. It is suitable for the clinical application in the treatment of hand trauma in the pediatric patients.