Is it True that Injecting Palmar Finger Skin Hurts more than Dorsal Skin? New Level 1 Evidence

Abstract

Background Since the first texts on local anesthesia were written in the early 1900s, it has been widely quoted and believed that dorsal finger skin is less sensitive to needlestick pain than volar finger skin. The result is that the most commonly used finger block for local anesthesia is the dorsal two injection technique. Methods In this study, the needlestick discomfort associated with dorsal and volar finger skin was compared in a group of 78 volunteers who had the long finger of both hands poked with a 25 G needle; one in the midline of the volar side and the other in the lateral web space of the dorsal side. Volunteers then completed a pain scale for each needlestick and ranked which technique they would prefer for future injections. Results We found that there was no significant difference in needlestick pain or preference of future needle location between the dorsal and volar aspects of the finger. Conclusions We provide level 1 evidence that the needlestick of the SIMPLE block which has one needlestick on the volar side of the finger is not more painful than the needlestick of the dorsal finger block.

CONSORT 2010 statement: extension checklist for reporting within person randomised trials

“…Also, the investigator performed a clinical assessment of each lesion achieving complete response regarding the following signs and symptoms: scarring, atrophy, induration, redness, or change in pigmentation." 41 Example 3: Patient preference outcome-"The order of needle sticks was randomized according to side of the hand (volar vs dorsal) and order of long fingers (right vs left). All needlesticks were performed with a standard technique by only two investigators.…”

“…The participant was then asked to rank 'which hand they would prefer to receive an injection in if it was required in the future." 41 Example 4: Patient preference outcome-"Preference of the eyelid warming techniques (eye mask, eye bag, or no preference) was also recorded after treatment." 42 Explanation-Complete definition of outcomes should include the timing and method of the measurement.…”

The wide-awake approach to ulnar nerve entrapment: results of an integrated one-stop wide-awake surgical pathway

“…This refutes decades of surgical dogma 1,2,9-13 . The injection technique can be optimised to minimise the associated pain 14 .…”

CONSORT 2010 statement: extension checklist for reporting within person randomised trials

“…Secondary safety end points included the investigator's local tolerance preference (one week after baseline session) and incidence of adverse events (AEs) throughout the study. Also, the investigator performed a clinical assessment of each lesion achieving complete response regarding the following signs and symptoms: scarring, atrophy, induration, redness, or change in pigmentation.”…”

“…Following both needlesticks they had to rank the discomfort associated with each needlestick on a scale of 0 (no pain) to 10 (worst pain imaginable). The participant was then asked to rank ‘which hand they would prefer to receive an injection in if it was required in the future.”…”