Transthecal Digital Block: An Underutilized Technique In The ED

Hart, Raymond G.; Fernandas, F.A.S.; Kutz, Joseph E.

doi:10.1016/j.annemergmed.2006.11.024

Cited by 2 publications

(3 citation statements)

References 0 publications

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“…• Dangers: nerve injury The advantage of this approach is that it more reliably anesthetizes the dorsoproximal aspect of the phalanx. 33,34 This comes at the expense of two injection sites. The extremity should be pronated with the palm down on a flat surface.…”

Section: Anatomymentioning

confidence: 99%

“…• Dangers: digital nerve injury, theoretical digit gangrene discussed in the Nerve Block section, and flexor tendon damage. 33,34 The advantage of this approach is that it can be done through a single injection site. This is at the expense of inserting the needle through the more sensitive palmar dermis and inconsistent anesthesia of the dorsoproximal phalanx.…”

Section: Approach-transthecalmentioning

confidence: 99%

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Safe and Effective Aspirations and Nerve Blocks for the On-Call Orthopaedic Surgeon

Berger

Schwartz

Kent

2023

J Am Acad Orthop Surg

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The on-call orthopaedic surgeon is faced with a wide array of orthopaedic pathology for which intra-articular aspiration, injection, and/or nerve/hematoma block may be used. Efficient use of these diagnostic and therapeutic modalities affords better patient care and a more effective on-call period. Often, these interventions are the rate limiting factor in a reduction or diagnosis. In this review, we describe joint aspirations, saline load tests, hematoma blocks, and nerve blocks in detail to include their indications, techniques, related pharmacology, pearls, and pitfalls. Whether on call or in the clinic, intra-articular aspirations and injections play a large role in an orthopaedic surgeon's diagnostic and therapeutic toolbox. Furthermore, fracture site injections in the form of hematoma blocks are an incredibly powerful local pain control modality to facilitate acute fracture reductions. Finally, accessing a joint as a part of a saline load test (SLT) in the setting of a potential traumatic arthrotomy is an important skill to master. These diagnostic and therapeutic tools require the orthopaedic surgeon to have an intimate knowledge of indications, anatomy, pharmacology, and potential pitfalls. In this review, we discuss these details for joint aspirations, SLTs, hematoma blocks, and nerve blocks.Of note, ultrasonography-guided joint access has been reported and is used in practice, particularly in the realm of emergency medicine. However, we will not be discussing any ultrasonography-guided techniques in this technique guide. In addition, there are broad and highly debated indications for joint injection for pain management and osteoarthritis diagnosis. However, these procedures are by-and-large done in the nonacute clinic setting and will also not be covered in this review. With that said, many of the techniques discussed herein are also applicable to the clinic setting. Joint AspirationThe on-call orthopaedic surgeon is faced with a variety of atraumatic intraarticular pathologies including infection, osteoarthritis, rheumatoid arthritis, crystalline arthropathy, and others. Outside of radiographic and clinical evaluation, arthrocentesis is a powerful tool for these patients.

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Section: Anatomymentioning

confidence: 99%

Section: Approach-transthecalmentioning

confidence: 99%

Safe and Effective Aspirations and Nerve Blocks for the On-Call Orthopaedic Surgeon

Berger

Schwartz

Kent

2023

J Am Acad Orthop Surg

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“…Several nerve block techniques are described for providing digital anaesthesia to facilitate the assessment and treatment of such injuries . These include the traditional double‐dorsal subcutaneous (SC) injection (‘ring blocks’), single‐volar SC injection (‘intermetacarpal blocks’) and single‐volar transthecal injection.…”

Section: Introductionmentioning

confidence: 99%