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Sneak Peak "Trick of the Trade": Digital nerve block

2016-10-26T17:05:43+00:00

The digital nerve block is common performed in the Emergency Department to provide anesthesia prior to wound closure. The digital nerves are typically accessed by injecting in the webspace on either side of the finger.

Have you had patients start to get sweaty and anxious merely at the sight of your drawing up lidocaine in the syringe? Despite your reassurance that the 18-gauge needle that you used was just to move the lidocaine into the syringe and that you’ll be using a small needle for the procedure, they don’t look very reassured. Trust is key to having the procedure go smoothly.

Two tricks that I use to minimize anxiety revolve around the following 2 premises:

  1. Ignorance is bliss
  2. Patients equate syringe size (not needle size) with pain intensity

Trick #1:

There is absolutely no need to draw up lidocaine into a syringe within eye-shot of the patient. The patient does NOT need to see the 18-gauge needle used to load licocaine into the syringe. (Our nurse Megan and Dr. Malini Singh are having way too much fun drawing up meds in the above photo.) Only approach the patient after you’ve got the lidocaine in the syringe with a teeny-tiny needle at the end. Ideally a 27-30 gauge needle is best to minimize pain.

Trick #2:

Use small volume syringes. I commonly use the above 1 mL tuberculin/insulin syringe to inject the lidocaine. These syringes are attached to innocuous-looking 29-gauge needles. Pediatric patients especially are less intimidated by these skinny syringes. After loading 2 syringes with the anesthetic prior to entering the room, I inject 1 mL each into the radial and ulnar aspect of the digit base. I instill the last 0.2-0.3 mL of anesthetic as I exit the skin.

The larger syringes do look quite scary…


Question: What tricks do you use to minimize anxiety during procedures?

Michelle Lin, MD
ALiEM Editor-in-Chief
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD