Pediatric emergency medicine trisk 1113
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FIGURE 130.47 Field block for local anesthesia.
An alternative approach to the digital nerve block is to block the nerve at the
level of the metacarpophalangeal joint or just proximal to it. This method may be
less painful and may have fewer complications than a more distal block. The
block is performed by inserting a 25-gauge, 5/8-in needle along each side of the
metacarpal at the interdigital fold in line with the web space. Insert the needle
into the web space until the tip is at the level of the metacarpophalangeal joint (1
to 2 cm) and inject 1 to 2 mL of 1% lidocaine ( Fig. 130.48A , part D). For the
index finger, place a half-ring wheal of lidocaine along the radial side of the
proximal aspect of the finger. For the fifth digit, inject a similar wheal along the
ulnar border to anesthetize the lateral aspect. For the thumb, a half-ring wheal of
lidocaine can be placed along the radial aspect of the metacarpophalangeal joint.
The web space between the thumb and index finger is approached as outlined
above.
Proximal digital nerve block. Figure 130.48A , part A shows the location of
the more proximal block (see the open circles). Inject these areas when the entire
finger, including the proximal phalanx, must be anesthetized. The nerve is closer
to the palmar surface here, making it best to inject the anesthetic closer to the
palmar surface.
Supraorbital Nerve Block
Indications
1. Lacerations within sensory distribution of the nerve ( Fig. 130.48B )
2. Removal of a foreign body
