Digital Block


  • 1.

    Two techniques can be used to perform a digital block:

    • a.

      Tendon sheath injection

    • b.

      Web space injection

  • 2.

    The web space injection technique is more painful but provides a complete digital block more reliably.

Indications for Use

A digital block is used for soft tissue injuries about the finger distal to the proximal interphalangeal joint.


  • 1.

    Warnings not to use epinephrine in a digit are based on misinterpretations of invalidated data.

  • 2.

    Do not use a digital block if the metacarpophalangeal (MP) joint is surrounded by infection.


When administering a tendon sheath injection, the dorsal block can be enhanced by skirting the tendon sheath on either side and injecting on the dorsum of the hand.


  • 1.

    Antiseptic: A chlorhexidine prep stick or alcohol-soaked gauze

  • 2.

    Syringe: A 10-mL syringe

  • 3.


    • a.

      A large-bore, blunt-tipped drawing-up needle

    • b.

      A 1½-in., 25-gauge needle

  • 4.

    Anesthetics (for a typical adult):

    • a.

      Lidocaine: 5 mL of 2%

    • b.

      Bupivacaine: 5 mL of 0.5%

  • 5.

    Sterile gloves

  • 6.

    4 × 4 in. gauze

Basic Technique

  • 1.

    Patient positioning: Place the hand on a bedside table with the arm in pronation.

  • 2.


    • a.

      The web space on either side of the affected digit or tendon sheath.

    • b.

      The digital nerves are injected on either side of the affected digit.

  • 3.


    • a.

      Position the patient.

    • b.

      Prepare the anesthetic.

    • c.

      Palpate the landmarks.

    • d.

      Prepare the skin with an antiseptic solution.

    • e.

      Numb the skin with ethyl chloride (if desired).

    • f.

      Inject the anesthetic:

      • (1)

        Inject the anesthetic on both sides for a web space block.

      • (2)

        Inject the anesthetic on the volar tendon sheath and incorporate the dorsal skin.

    • g.

      Place a sterile bandage over the injection site.

Detailed Technique

Aug 5, 2023 | Posted by in ORTHOPEDIC | Comments Off on Digital Block

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