Digital and Metacarpal Nerve Block

Fibers of the median and ulnar nerves give rise to the common digital nerves. Common digital nerves divide as they reach the distal palm after passing along the metacarpal bones. Volar digital nerves run along the ventrolateral aspect of the fingers alongside the digital vein and artery providing most of the sensation to the fingers. Fibers from the ulnar and radial nerves form the smaller dorsal digital nerves and supply the dorsum of the fingers up to the proximal joints.

Technique Preparation

Arrange sterile towels, sterile gloves, gauze pads, marking pen, antiseptic solution, syringes, and needles for local infiltration and nerve block placement.

Dose

5 ml syringes of local anesthetic. Needles

25 g 1.5 in. needle for skin infiltration. Agents

3% chloroprocaine, 2% lidocaine, 0.5% ropivacaine, 0.5% bupivacaine.

Surface Anatomy and Landmarks Landmarks

Digital nerve block (A) and metacarpal nerve block (B):

A. With the patient in the supine position, the arm is placed in an abducted position and the elbow slightly flexed. In a sterile fashion a 25 g 1.5 in. needle is used on each side of the base of the digit to be blocked from the dorsal to the palmar aspect of the finger. A total of 1-2 cc of local anesthetic is slowly injected after negative aspiration.

B. In an aseptic fashion, a 25 g 1.5 in. needle is inserted on either side of the metacarpal bone proximal to the metacarpal head from the dorsal all the way to the palmar surface of the hand. After negative aspiration 1-2 cc of local anesthetic is slowly injected and pressure is applied at the injection site after removal of the needle to prevent the formation of hematomas.

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