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Digital Block

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2881. Effect of digital pressure on the neurovascular sheath during perivascular axillary block. (PubMed)

Effect of digital pressure on the neurovascular sheath during perivascular axillary block. We have assessed prospectively the influence of digital pressure on the effectiveness of perivascular axillary block using a catheter technique in two groups of patients. Ninety-eight patients received axillary injections of 2% mepivacaine with adrenaline 20 ml mixed with contrast agent 20 ml. During injection firm digital pressure was applied either on the neurovascular sheath (group 1) or 6-8 cm below (...) it (group 2). The patient's arm was then adducted. Axillary radiographs were obtained in 90 patients after 30 min. In the last eight patients radiographs were obtained after injecting 2, 20 and 40 ml of the mixture to study the dynamics of spread. There were no statistically significant differences in proximal flow of mepivacaine or in the success rate of the block between the groups. Signs of flow obstruction by the head of the humerus were seen in only eight patients. In the majority of patients local

1995 British Journal of Anaesthesia Controlled trial quality: uncertain

2882. Digital pressure during interscalene block is clinically ineffective in preventing anesthetic spread to the cervical plexus. (PubMed)

Digital pressure during interscalene block is clinically ineffective in preventing anesthetic spread to the cervical plexus. The application of digital pressure above the injection site during interscalene block has been advocated to prevent cephalad spread of local anesthetic. In prior studies, radiographs taken immediately after interscalene injection of radiographic contrast have supported this concept. However, the clinical efficacy of digital pressure has not been previously tested (...) . If digital pressure were effective in inhibiting cephalad spread of local anesthetic, attenuation of both hemidiaphragmatic paresis and the resulting compromise in pulmonary function would be expected. Sensory, motor, and pulmonary effects were prospectively evaluated in 20 patients presenting for elective shoulder surgery. Patients were randomly assigned to receive interscalene block with or without digital pressure. No clinical differences were seen between groups. All 20 patients had ipsilateral

1996 Anesthesia and analgesia Controlled trial quality: uncertain

2883. Comparison between single injection transthecal and subcutaneous digital blocks. (PubMed)

Comparison between single injection transthecal and subcutaneous digital blocks. A randomized double blinded study was performed on 142 patients to evaluate two different techniques of single injection digital anaesthesia. In group A, 86 digits in 71 patients were anaesthetized by a single injection transthecal technique using 3 cc of lignocaine and bupivacaine mixture. Anaesthesia of the whole digit was achieved in 83 (97%) digits. In group B, 80 digits in 71 patients were anaesthetized (...) with a single injection subcutaneous technique using the same amount of anaesthetic mixture. Total anaesthesia of the digit was achieved in 75 (94%) digits. These two techniques were found to have no differences in effectiveness, distribution, onset and duration of anaesthesia.

1997 Journal of hand surgery (Edinburgh, Scotland) Controlled trial quality: uncertain

2884. Comparison of transthecal and subcutaneous single-injection digital block techniques in cadaver hands. (PubMed)

Comparison of transthecal and subcutaneous single-injection digital block techniques in cadaver hands. A controlled, randomized single-blinded study was performed on the thumbs and little fingers of 20 cadaver hands. The digits were randomly divided into 2 groups. In the transthecal group, 2 mL of 0.5% methylene blue was injected into the tendon sheath at the A1 pulley. In the subcutaneous group, the same amount of dye was injected into the subcutaneous tissue superficial to the A1 pulley (...) . The injections were performed by 2 investigators. They exchanged specimens and performed dissections on the injected digits without knowledge of which technique had been used. The distributions of dye along the digit and the color intensity of the dye on the digital nerves were studied. There was no significant difference (p > .05) between results for the 2 techniques. It was expected that both techniques would result in similar anesthetic distribution in the clinical setting. In the transthecal group, intra

1997 The Journal of hand surgery Controlled trial quality: uncertain

2885. Comparison of transthecal and subcutaneous single-injection digital block techniques. (PubMed)

Comparison of transthecal and subcutaneous single-injection digital block techniques. A randomized double-blinded study was performed on 20 normal volunteers to evaluate 2 different techniques of single-injection digital anesthesia. Single-injection transthecal digital block technique was used to anesthetize 1 index finger and single-injection subcutaneous technique to block the other index finger. Pain and light touch were evaluated and sensory nerve-conduction studies were performed on both (...) index fingers. These data were obtained prior to the nerve blocks and then at 10-minute intervals until recovery from the anesthesia. The method of anesthesia was found to have no effect on the distribution, onset, and duration of anesthesia. Median and radial nerve sensory nerve action potential amplitude reductions following digital anesthesia were also not influenced by the technique of anesthesia. Single-injection subcutaneous block was found to be easier to administer and to produce less pain

1997 The Journal of hand surgery Controlled trial quality: uncertain

2886. The use of EMLA reduces the pain associated with digital ring block for ingrowing toenail correction. (PubMed)

The use of EMLA reduces the pain associated with digital ring block for ingrowing toenail correction. Treatment of ingrowing toenail is commonly performed under local anaesthesia with a digital ring block. Ring block can be associated with significant pain, caused by needle insertion and deposition of the local anaesthetic agent. EMLA, a topical anaesthetic cream, is widely used to alleviate the pain of venepuncture. The aim of this study was to investigate whether the discomfort of digital (...) in Group 1 was 28.1 and 50.1 in Group 2 (P < 0.0001). We conclude that EMLA significantly reduces the pain associated with digital ring block.

2000 European Journal of Anaesthesiology Controlled trial quality: uncertain

2887. Do not use epinephrine in digital blocks: myth or truth? (PubMed)

Do not use epinephrine in digital blocks: myth or truth? The purpose of this study was to examine the role for epinephrine augmentation of digital block anesthesia by safely prolonging its duration of action and providing a temporary hemostatic effect. After obtaining approval from the review board of the authors' institution, 60 digital block procedures were performed in a prospective randomized double-blinded study. The digital blocks were performed using the dorsal approach. All anesthetics (...) were delivered to treat either posttraumatic injuries or elective conditions. Of the 60 digital block procedures, 31 were randomized to lidocaine with epinephrine and 29 to plain lidocaine. Of the procedures performed using lidocaine with epinephrine, one patient required an additional injection versus five of the patients who were given plain lidocaine (p = 0.098). The need for control of bleeding required digital tourniquet use in 20 of 29 block procedures with plain lidocaine and in 9 of 31

2001 Plastic and reconstructive surgery Controlled trial quality: uncertain

2888. Digitally assisted acromioplasty: the effect of interscalene block on this new surgical technique. (PubMed)

Digitally assisted acromioplasty: the effect of interscalene block on this new surgical technique. Interscalene brachial plexus (ISBP) block has been shown to be safe and effective for shoulder surgery with significant benefits. The purpose of this study was to introduce the technique of digitally assisted acromioplasty and assess the effect of ISBP on rehabilitation.Randomized controlled prospective trial.In a randomized prospective trial of 40 patients undergoing acromioplasty under general (...) anesthesia, 20 patients received an ISBP block (group 1) and 20 had no block (group 2). A digitally assisted acromioplasty was performed using a burr introduced via a posterior portal. The undersurface of the acromion was debrided, directing the burr with the surgeon's index finger introduced via a small lateral incision. Independent review was at day 1, day 2, week 1, week 6, and 1 year.Group 1 had significantly greater shoulder motion and shoulder score, and less pain and analgesic requirements

2001 Arthroscopy Controlled trial quality: uncertain

2889. EMLA cream prior to digital nerve block for ingrown nail surgery does not reduce pain at injection of anesthetic solution. (PubMed)

EMLA cream prior to digital nerve block for ingrown nail surgery does not reduce pain at injection of anesthetic solution. Needle penetration and local anesthetic infiltration are painful steps of digital ring block. The objective of this study was to evaluate the efficacy of EMLA cream application prior to digital ring block for surgery for ingrown big toenail.We conducted a prospective, double-blinded, placebo-controlled, randomized clinical trial with 81 patients (range: 12-75 years, mean (...) +/- SD: 30.3 +/- 17.5 years), who underwent big toenail surgery. Prior to the digital block, EMLA cream (Group E) or a placebo cream (Group P) was applied. A visual analog scale (VAS) and a verbal rating score (VRS) from 1 to 10, 10 being most severe pain, were used for assessment of pain during the skin needle penetration and during the infiltration of the anesthetic product.Data of the VAS and of the VRS during the two steps, respectively, show no significant difference in pain rating between

2002 Acta Anaesthesiologica Scandinavica Controlled trial quality: uncertain

2890. Single injection digital block: comparison between three techniques. (PubMed)

Single injection digital block: comparison between three techniques. Regional anesthesia of a single finger is commonly achieved by the traditional ring block. The major drawback of this technique is the need for at least two painful injections in the digit. Single injection techniques have been described. A comparison of their results could help health professionals select the most appropriate technique.A prospective randomized study was designed to compare three techniques in term of patient (...) tolerance, distribution of anesthesia and efficiency: the modified transthecal digital block, the subcutaneous digital block and a combination of the two. Digits were randomized in three groups (n = 30). Blocks were performed by a single investigator. A visual analogic scale was used to evaluate pain associated with the injection. Prick-testing was used to evaluate anesthesia at the volar and dorsal aspects of the phalanxes. Statistical analysis of the results was performed.All techniques allowed

2002 Chirurgie de la main Controlled trial quality: uncertain

2891. Modified transthecal digital block versus traditional digital block for anesthesia of the finger. (PubMed)

Modified transthecal digital block versus traditional digital block for anesthesia of the finger. This study compared the modified transthecal digital block (MTDB) technique with the traditional digital block (TDB) according to the degree of discomfort caused by injection and to the onset and the duration of anesthesia.This was a prospective, randomized, double-blinded, and controlled study. The same investigator performed all blocks to the middle fingers of each hand. The hand anesthetized (...) and type of block (TDB or MTDB) received first were both randomized. An orientation was given to the 25 participants detailing how to evaluate their own degree of anesthesia. This orientation included establishing a baseline of sensation with a safety pin, a description and diagram of 12 zones of the finger, an explanation of the 10-cm visual analog pain scale, and an explanation of how to record anesthesia progress in the fingers. On completion of each block, the subjects recorded the degree of pain

2004 The Journal of hand surgery Controlled trial quality: uncertain

2892. Comparison of transthecal digital block and traditional digital block for anesthesia of the finger. (PubMed)

Comparison of transthecal digital block and traditional digital block for anesthesia of the finger. A randomized, double-blind study was performed in 50 patients to compare the transthecal and traditional subcutaneous infiltration techniques of digital block anesthesia regarding the onset of time to achieve anesthesia and pain during the infiltration. All the patients had sustained injury involving two or four fingers of the hand. Each patient served as his or her own control, having one finger (...) for the subcutaneous infiltration block. The mean analogue pain score was higher for transthecal blocks than for subcutaneous infiltration blocks (3.2 +/- 0.19 versus 1.6 +/- 0.14). Twenty-four hours postoperatively, 24 patients who had the transthecal block experienced pain at the injection site of the digit. However, none of the patients who received the subcutaneous infiltration block complained of pain at the digit. The technique of anesthesia preferred by patients for their finger was the subcutaneous

2004 Plastic and reconstructive surgery Controlled trial quality: uncertain

2893. A comparison of traditional digital blocks and single subcutaneous palmar injection blocks at the base of the finger and a meta-analysis of the digital block trials. (PubMed)

A comparison of traditional digital blocks and single subcutaneous palmar injection blocks at the base of the finger and a meta-analysis of the digital block trials. A randomised, double-blinded, controlled trial was performed to compare traditional digital blocks with single subcutaneous palmar injection blocks at the base of the finger. A search for randomised controlled trials of digital blocks through MEDLINE, EMBASE, Cochrane Controlled Trials Register and CBM was conducted and a meta (...) -analysis including the current trial was performed. The current trial showed no difference between traditional digital blocks and single subcutaneous palmar injection bocks at the base of the finger in respect of injection pain and time to anaesthesia. The meta-analysis suggests that traditional digital blocks and single subcutaneous palmar injection blocks are similar with regard to injection pain and are less painful than the transthecal digital block. The palmar techniques, including single

2006 Journal of hand surgery (Edinburgh, Scotland)

2894. Phrenic nerve block caused by interscalene brachial plexus block: effects of digital pressure and a low volume of local anesthetic. (PubMed)

Phrenic nerve block caused by interscalene brachial plexus block: effects of digital pressure and a low volume of local anesthetic. Interscalene brachial plexus block (ISB) is associated with phrenic block and diaphragmatic paralysis when high volumes (40-50 mL) of local anesthetic are injected. The goal of our study was to test if a low volume of local anesthetic administered while maintaining proximal digital pressure might more selectively block the brachial plexus and decrease the frequency (...) of phrenic nerve block.Twenty healthy patients undergoing ISB for orthopedic surgery of the upper extremity were randomly allocated to receive either 20 mL 1.5% mepivacaine while proximal digital pressure to the site of puncture was performed, or 40 mL 1.5% mepivacaine without digital pressure. Spirometry and clinical data were evaluated at baseline, 10, and 90 minutes after accomplishing the block and after the motor and sensory block resolved. Diaphragmatic excursion during deep inspiration was also

1999 Regional Anesthesia and Pain Medicine Controlled trial quality: uncertain

2895. Suturing of digital lacerations: digital block or local infiltration? (PubMed)

Suturing of digital lacerations: digital block or local infiltration? 2064671 1991 05 17 2008 11 20 0035-8843 73 2 1991 Mar Annals of the Royal College of Surgeons of England Ann R Coll Surg Engl Suturing of digital lacerations: digital block or local infiltration? 130-1 eng Comment Letter England Ann R Coll Surg Engl 7506860 0035-8843 IM Ann R Coll Surg Engl. 1990 Nov;72(6):360-1 2241053 Anesthesia, Local Finger Injuries surgery Fingers innervation Humans Nerve Block Sutures 1991 3 1 1991 3 1

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1991 Annals of the Royal College of Surgeons of England

2896. Suturing of digital lacerations: digital block or local infiltration? (PubMed)

Suturing of digital lacerations: digital block or local infiltration? 19311333 2010 06 25 2010 06 25 0035-8843 73 2 1991 Mar Annals of the Royal College of Surgeons of England Ann R Coll Surg Engl Suturing of digital lacerations: digital block or local infiltration? 131 Evans D M DM eng Journal Article England Ann R Coll Surg Engl 7506860 0035-8843 2009 3 25 9 0 1991 3 1 0 0 1991 3 1 0 1 ppublish 19311333 PMC2499383

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1991 Annals of the Royal College of Surgeons of England

2897. Suturing of digital lacerations: digital block or local infiltration? (PubMed)

Suturing of digital lacerations: digital block or local infiltration? A prospective trial was carried out to assess the relative efficiency of digital block and local infiltration as methods of anaesthesia when suturing lacerations of the digits. A standard technique and questionnaire were applied to a consecutive group of 62 patients attending the Accident Department of the Bristol Royal Infirmary. Digital block was found to be a more effective technique than local infiltration (...) for anaesthetising digital lacerations.

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1990 Annals of the Royal College of Surgeons of England Controlled trial quality: uncertain

2898. Comparison of transthecal digital block and traditional digital block for anesthesia of the finger. (PubMed)

Comparison of transthecal digital block and traditional digital block for anesthesia of the finger. To compare the newly described transthecal (TT) and traditional (TD) methods of digital block anesthesia with regard to length of time to achieve anesthesia and pain during infiltration.Prospective, randomized, controlled, blinded study.Healthy adult paid volunteers.Each subject received a TT block on one hand and a TD block on the opposite hand. All blocks were performed by the same investigator (...) and were rated by an evaluator who was blinded to the technique that was used. Time to loss of pin-prick sensation was measured, and the pain of the procedure was recorded by the subject on a 10-cm visual-analog scale.A total of 162 blocks (81 TT and 81 TD) were performed in 31 different subjects. All blocks were successful. Mean time to anesthesia for TT block was 188 seconds compared with 152 seconds for the TD block (P < .01). Mean analog pain score was slightly higher for TT block than for TD block

1995 Annals of Emergency Medicine Controlled trial quality: uncertain

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