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Report by Stuart McKirdy, Senior House Officer Search checked by Simon Carley, Specialist Registrar
Clinical scenario
A 25 year old man presents to the emergency department after a crush injury to the left middle finger. There is a laceration over the distal phalanx involving the nail bed, which is disrupted. You wish to achieve local anaesthesia to allow wound exploration and repair and wonder whether ring block or metacarpal block is the best approach.
Three part question
In [patients requiring local anaesthesia to the finger] is [metacarpal block better than ring block] at [minimising pain during infiltration, achieving adequate anaesthesia and achieving rapid onset]?
Search strategy
Medline 1966–03/00 using the OVID interface. [({exp wounds and injuries OR in-jur$.mp} AND {exp fingers OR finger$.mp OR digit$.mp}) AND {exp nerve block OR nerve block.mp OR exp anesthesia,local OR local anesthesia.mp OR ring block.mp] LIMIT to human AND english.
Search outcome
Altogether 66 papers were found of which 65 were irrelevant or of insufficient quality for inclusion. The one remaining paper is shown in table 8.
Comment
The results of a single study must be interpreted with caution especially as practical procedures are operator dependent and high failure rates may reflect operator error rather than intrinsic problems. Metacarpal blocks may still have a role when anaesthesia is required in more than one finger, when proximal anaesthesia is needed or when the circulation to the finger is suspect.
Clinical bottom line
Digital nerve (ring) block is the technique of choice for emergency digital anaesthesia.
Report by Stuart McKirdy, Senior House Officer Search checked by Simon Carley, Specialist Registrar