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Digital anaesthesia: one injection or two?
  1. Beverley Cannon1,
  2. Louisa Chan2,
  3. Joanna S Rowlinson3,
  4. Matthew Baker4,
  5. Mike Clancy
  1. 1Emergency Department, Queen Alexandra Hospital, Portsmouth, UK
  2. 2SpR Emergency Medicine, North Hampshire Hospital, Basingstoke, UK
  3. 3SpR Emergency Medicine, Southampton General Hospital, Southampton, UK
  4. 4SpR Emergency Medicine, Queen Alexandra Hospital, Portsmouth, UK
  5. 5Emergency Department, Southampton General Hospital, Southampton, UK
  1. Correspondence to Dr J S Rowlinson, Emergency Department, Southampton General Hospital, Tremona Road, Southampton SO16 6YD UK; jrowlinson{at}doctors.org.uk

Abstract

Background Digital nerve blocks (DNB) are performed frequently in the Emergency Department (ED). The aim of this study was to establish whether single injection subcutaneous digital nerve block (SDNB) is as effective as the traditional (two injection) digital nerve block (TDNB) for digital anaesthesia.

Method Single blinded, prospective, randomised-controlled multicentre trial within Hampshire EDs. Patients ≥16 years attending the ED with fingertip injuries/infections (distal to the distal-interphalangeal joint) requiring a DNB were randomised to SDNB/TDNB groups. Outcome measures were: primary ‑ successful anaesthesia; secondary ‑ patient distress, clinician satisfaction (CS), complications.

Results 76 patients were randomised. (37 received SDNB). At 5 min, more patients in the SDNB group (28/37, 76%) were adequately anaesthetised than in the TDNB group, (22/34, 65%). At 10 min, 33/37 (89%) of the SDNB group compared to 28/34 (82%) of the TDNB group were adequately anaesthetised. The mean (SD) of self-reported distress scores for the SDNB group were lower than those reported for the TDNB group, whereas the mean (SD) of CS scores for SDNB were higher than those reported for TDNB. Neither group reported complications from anaesthesia.

Conclusions SDNB is as effective as TDNB. Outcome measures favoured SDNB, but only CS scores achieved statistical significance. Trial recruitment is much slower than anticipated. However, clinical practice has demonstrated that SDNB works and practice is already changing within the Hampshire region, with some departments adopting SDNB as standard practice. Therefore, the results are being presented now to allow clinicians to make an informed choice. Our results may also contribute to future metanalyses.

  • anaesthesia - local
  • analgesia/pain control, digital nerve block
  • double injection, emergency medicine
  • hand injury, regional anaesthesia
  • regional analgesia, single injection
  • subcutaneous injection

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Footnotes

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Research Ethics Committee ref no: 07/Q1704/10 Southampton & South West Hampshire REC (B).

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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