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