Comparison of traditional two injections dorsal digital block with volar block

To compare the traditional two injections dorsal digital block with volar block in terms of effectiveness of anaesthesia and pain of initial pinprick.

Quasi-experimental.

AVH and casualty operation theatres, Mayo Hospital, KEMU, Lahore, from January to June 2007.

Thirty patients requiring surgical procedure distal to proximal phalanx crease on two fingers of same or one finger of both hands were included. Cases with allergy to lignocaine, previous vascular insufficiency, previous digital replantation or peripheral neuropathy were excluded. One finger of every patient received two injection dorsal block whereas the other finger received single subcutaneous injection in the midline of the phalanx with lignocaine and epinephrine (volar block). Patient looked away during the performance of block and wrote the severity of initial pinprick on a visual analogue scale. Effectiveness of anaesthesia was made measurable by the absence of pain during the surgical procedure. Total duration of the anaesthesia and any undesirable numbness of adjacent finger were noted. The t-test was used to compare the means and p-value less than 0.05 was considered significant.

The mean pain scale score were 4.27+0.87 and 5.27+1.05 for volar and dorsal techniques respectively (p < 0.05). Volar blocks were 100% effective whereas in dorsal blocks success rate was 80% (p < 0.05).

Single subcutaneous injection in the midline of phalanx with lignocaine and epinephrine (volar block) was significantly less painful to administer, is effective and safe technique to achieve digital anaesthesia, compared to the dorsal technique.