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SPM 200 Clinical Skills Lab 4
Local Anesthesia / Digital Block
Daryl P. Lofaso, M.Ed, RRT
Anatomy of Skin
Arteries of the Hand
Each hand has 4 digital arteries.
• Common Digital Arteries
• Dorsal Metacarpal Arteries
• Palmar Metacarpal Arteries
• Proper Digital Arteries
Nerves of the Hand
Digital nerves run down the medial and lateral sides of each digit.
Standard Precautions
All patients are potentially infectious. Good handwashing is the key to
reducing nosocomial infections Wash before and after patient contact Wear gloves, a mask, eye protection,
face shield and gown when contact with blood or other body fluids is likely
(a more detailed description can be found at: www.cdc.gov/ncidod/hip/blood/universa.htm)
Risks to You: Hepatitis B, C & HIV
Risk after Needle Stick Exposure
Hepatitis B: 6-30% Hepatitis C: 3 – 10% HIV: 0.3%
Management of Exposure
Wash immediately Report incident to
supervisor (3 red tops & file incident report)
Obtain history from the source patient (HIV, Hepatitis or risk factors)
Management of Exposure Report to Employee Health or
Emergency Department (LSU Interim Hospital Emergency Room)
Counseling will be provided regarding the need for post exposure prophylaxis (see CDC recommendations)
Indications Digital Block
Excellent anesthesia (dorsal and volar)
Repair of Lacerations beyond Metacarpal
Incisions and Abscesses and Paronychia
Nail removal
ContraindicationsDigital Block
Long procedure – short acting
Multiple injuries
Patient allergies
Commonly Used Anesthetics for Wound Repair
Lidocaine w/epi & w/o epi0.5 – 1.0 % (Duration 1-2 hrs)
Prilocaine0.5 - 1.0 % (Duration 15-45 min)
Bupivacaine0.25 % (Duration 4-8 hrs)
Safe → Etidocaine → Bupivacaine → Lidocaine → Less Safe
Use of Epinephrine
Increase anesthetic delivery Slow diffusion through tissue Increase the max dose of
anesthetic burns (acidic) Cut off circulation in areas (penis,
digit, tip of nose, earlobe
Complications of Local Anesthetic - Tx
Blanching of nearby skin – Stop Urticaria (hives) – Stop Syncope w/o edema – Monitor HR
& BP Arterial Puncture –Direct pressure Systemic Toxicity – CNS deficits
Contraindications Neuro Block
Pervious Reaction to Local Anesthetic
Liver Disease, Heart Disease, R/O Amide-Based Anesthetics
Previous use of MAO inhibitors Anesthetics will reduce healing in
wound
Warning Signs: Systemic Toxicity
Tinnitus, numbness of tongue, lightheadedness, drowsiness
Visual disturbances Muscle twitching, convulsions,
coma, apnea
Digital Block Injection Technique
Patient Injection Technique
Hints to Minimize Patient’s Pain
Small Needle Inject Anesthetic Slowly Add Sodium Bicarbonate –
basic solutions decrease burn
Warm Solution
Invasive/Non-Invasive Procedure Notes
Proper Patient Identification Site Verification Pre / Post Medication Pain Control Intra / Post-Procedural monitoring Complications, if any Management of complications