A revisit of transthecal digital block and traditional digital block for anesthesia of the finger

Mohammad Dehghani, Arsalan Mahmoodian


BACKGROUND: Finger injuries are very common and the majority can be treated under digital block anesthesia. Traditional digital block is one of the most commonly performed blocks by care providers in several medical fields. There is another less known method, transthecal (Pulley) block, in which local anesthesia is injected into the flexor tendon sheath.
METHODS: A randomized clinical trial was performed to compare the transthecal (Pulley) and traditional digital block with regard to the length of anesthesia and the need for another anesthetic method (due to insufficient anesthesia) as a supplement. We divided 100 patients who needed digital block due to finger injury, into two groups randomly. In each group the patients were anesthetized either by traditional or transthecal digital block. All blocks were performed by the same investigator.
RESULTS: Mean length of anesthesia was 34.2 minutes in the transthecal digital block method versus 33.8 minutes in the traditional digital block method (P>0.05). A repeated injection or local infiltration as a supplement was necessary only in 5 instances in the traditional digital block method (P<0.05).
CONCLUSIONS: Regarding fewer injections and reduced amounts of lidocaine, absence of neurovascular bundles damage and comparable length of anesthesia and no need to supplemental anesthesia, transthecal digital block is an appropriate alternative to traditional digital block.
KEY WORDS: Digital block, transthecal, pulley, finger, flexor tendon sheath.


Digital block, transthecal, pulley, finger, flexor tendon sheath.

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