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Published in: HAND 1/2011

01-03-2011 | Surgery Article

Is it true that injecting palmar finger skin hurts more than dorsal skin? New level 1 evidence

Authors: Margaret E. Wheelock, Martin LeBlanc, Bryan Chung, Jason Williams, Donald H. Lalonde

Published in: HAND | Issue 1/2011

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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.
Literature
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go back to reference Braun H, Harris ML. Operation on the extremities. Local anesthesia: its scientific basis and practical use, Philadelphia and New York, Lea & Febiger. (second 2nd American edition from the 6th revised German edition) Lea & Febiger: Philadelphia and New York, 1914;, chapter 16 (operations on the extremities) page 367 Braun H, Harris ML. Operation on the extremities. Local anesthesia: its scientific basis and practical use, Philadelphia and New York, Lea & Febiger. (second 2nd American edition from the 6th revised German edition) Lea & Febiger: Philadelphia and New York, 1914;, chapter 16 (operations on the extremities) page 367
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go back to reference Ramamurthy S, Anderson D. Anesthesia. In Green’s Operative Hand Surgery 5th ed. Volume 1, Philadelphia, Elsevier Churchill Livingstone, 2005, chapter 2 page 44 Ramamurthy S, Anderson D. Anesthesia. In Green’s Operative Hand Surgery 5th ed. Volume 1, Philadelphia, Elsevier Churchill Livingstone, 2005, chapter 2 page 44
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go back to reference Williams JG, Lalonde DH. Randomized comparison of the single-injection volar subcutaneous block and the two-injection dorsal block for digital anesthesia. Plastic and Recontructive Surg. 2006;1195–200. Williams JG, Lalonde DH. Randomized comparison of the single-injection volar subcutaneous block and the two-injection dorsal block for digital anesthesia. Plastic and Recontructive Surg. 2006;1195–200.
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go back to reference Yin ZG, Zhang JB, Kan SL et al. A comparison of traditional digital blocks and single subcutaneous palmar injection blocks at the base of the finger and a meta analysis of the digital block trials. J Hand Surg 2006;547–55. Yin ZG, Zhang JB, Kan SL et al. A comparison of traditional digital blocks and single subcutaneous palmar injection blocks at the base of the finger and a meta analysis of the digital block trials. J Hand Surg 2006;547–55.
Metadata
Title
Is it true that injecting palmar finger skin hurts more than dorsal skin? New level 1 evidence
Authors
Margaret E. Wheelock
Martin LeBlanc
Bryan Chung
Jason Williams
Donald H. Lalonde
Publication date
01-03-2011
Publisher
Springer-Verlag
Published in
HAND / Issue 1/2011
Print ISSN: 1558-9447
Electronic ISSN: 1558-9455
DOI
https://doi.org/10.1007/s11552-010-9288-2

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