Appropriate Digital Nerve Block Technique: The Single-Injection Subcutaneous Volar Block Versus the Two-Injection Dorsal Digital Block

Background: Finger injuries are a common chief complaint in the emergency department (ED) and primary care setting. Repair of these injuries often require digital anesthesia through performing a digital nerve block (DNB). The two-injection subcutaneous volar block (SVB) and a two-injection dorsal digital block (DDB) are two of the most prevalently performed digital blocks in practice today. This systematic review examines which DNB technique is most appropriate and attempts to offer a recommendation for a standardized level of care. Methods: An extensive literature search was performed using Medline-OVID, Medline-PubMed, CINAHL, and Google Scholar. The following keywords were searched individually and in combination: digital anesthesia, digital block, and finger block. Inclusion criteria consisted of trials comparing the SVB and the DDB from 2007 to present. All articles were assessed for quality using GRADE. Results: The search resulted in 114 articles that were narrowed down to 32 by limiting articles to human studies written in English and published after 2007. The abstracts and titles were then hand searched for trials comparing the SVB and the DDB. Final articles meeting all inclusion criteria were three studies, two RCTs and one quasi-experimental. The primary outcome of successful anesthesia was measured and the quasiexperimental showed the SVB being more effective than the DDB and the two RCTs provided data with no significant difference between the two digital blocks. A secondary outcome of the patients’ pain score of the injection was also measured by two of the studies and no statistical significance was found. Conclusion: The SVB is equally effective in delivering anesthesia as the DDB but is only a single injection making it less invasive, easier to perform and teach, and avoids the risk of damaging the finger nerves. For these reasons a safe recommendation come be made for the use of the SVB when repairing a finger injury that is not located on the dorsal aspect of the proximal phalanx in which case is the only clinical scenario that the DDB should be utilized. Degree Type Capstone Project Degree Name Master of Science in Physician Assistant Studies First Advisor Annjanette Sommers, MS, PA-C Subject Categories Medicine and Health Sciences Rights Terms of use for work posted in CommonKnowledge. This capstone project is available at CommonKnowledge: http://commons.pacificu.edu/pa/510 Copyright and terms of use If you have downloaded this document directly from the web or from CommonKnowledge, see the “Rights” section on the previous page for the terms of use. If you have received this document through an interlibrary loan/document delivery service, the following terms of use apply: Copyright in this work is held by the author(s). You may download or print any portion of this document for personal use only, or for any use that is allowed by fair use (Title 17, §107 U.S.C.). Except for personal or fair use, you or your borrowing library may not reproduce, remix, republish, post, transmit, or distribute this document, or any portion thereof, without the permission of the copyright owner. [Note: If this document is licensed under a Creative Commons license (see “Rights” on the previous page) which allows broader usage rights, your use is governed by the terms of that license.] Inquiries regarding further use of these materials should be addressed to: CommonKnowledge Rights, Pacific University Library, 2043 College Way, Forest Grove, OR 97116, (503) 352-7209. Email inquiries may be directed to:. [email protected] This capstone project is available at CommonKnowledge: http://commons.pacificu.edu/pa/510 NOTICE TO READERS This work is not a peer-reviewed publication. The Master’s Candidate author of this work has made every effort to provide accurate information and to rely on authoritative sources in the completion of this work. However, neither the author nor the faculty advisor(s) warrants the completeness, accuracy or usefulness of the information provided in this work. This work should not be considered authoritative or comprehensive in and of itself and the author and advisor(s) disclaim all responsibility for the results obtained from use of the information contained in this work. Knowledge and practice change constantly, and readers are advised to confirm the information found in this work with other more current and/or comprehensive sources. The student author attests that this work is completely his/her original authorship and that no material in this work has been plagiarized, fabricated or incorrectly attributed.