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
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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
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Risk after Needle Stick Exposure
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Hepatitis B:
Hepatitis C:
HIV:
6-30%
3 – 10%
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
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Excellent anesthesia (dorsal and
volar)
Repair of Lacerations beyond
Metacarpal
Incisions and Abscesses and
Paronychia
Nail removal
Contraindications
Digital Block
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Long procedure – short acting
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Multiple injuries
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Patient allergies
Commonly Used Anesthetics
for Wound Repair
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Lidocaine w/epi & w/o epi
0.5 – 1.0 %
(Duration 1-2 hrs)
Prilocaine
0.5 - 1.0 %
(Duration 15-45 min)
Bupivacaine
0.25 %
(Duration 4-8 hrs)
Safe → Etidocaine → Bupivacaine → Lidocaine → Less Safe
Use of Epinephrine
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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
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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
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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
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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
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Small Needle
Inject Anesthetic Slowly
Add Sodium Bicarbonate – basic
solutions decrease burn
Warm Solution
Invasive/Non-Invasive
Procedure Notes
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Proper Patient Identification
Site Verification
Pre / Post Medication Pain Control
Intra / Post-Procedural monitoring
Complications, if any
Management of complications