• Riaz Ahmed Khan Afridi
  • Tariq Masood
  • Ehtisham Ahmed
  • Abdul Majeed Jaffar
  • Obaid ullah
  • Hamid Fazeel Alvi


Background: Digital nerve blocks are commonly used as effective techniques of anaesthesia to allow a variety of surgical procedures performed on digits. This study was conducted to compare the efficacy of volar subcutaneous single injection block and the traditional dorsal two injections digital block. Methods: This randomized controlled trial was conducted at Plastic and Reconstructive Surgery Department, Hayatabad Medical Complex Peshawar from December. 2009–10. A total of 126 patients with pathology distal to the first palmer digital crease divided into two equal groups. Group A received volar subcutaneous digital block while group B dorsal two injections block. Efficacy of digital block was measured in terms of time of onset of anaesthesia, which was the total time duration after administering local anaesthetic to loss of pinprick sensation and total duration of anaesthesia, which was defined as the time period from onset of block (loss of pinprick sensation) till the appearance of pain which required additional local anaesthetic or postoperative analgesia. Results: A total of 126 patients were studied, 63 in each group. Of the total patients, 102 (81%) were male and 24 (19%) female with a mean age of 27±4.2 years (range 17–60 years). The mean time of onset of anaesthesia from injection till the loss of pin prick sensation was 3.32±0.42 minutes for volar single injection group and 4.53 minutes±0.57 minutes for dorsal two injections group (p=0.049). Similarly the mean total duration of anaesthesia for the volar subcutaneous group was 271.9±29.34 minutes while for the dorsal two injections group, it was 229.52±28.82 minutes (p=0.415). Conclusion: Single injection volar subcutaneous digital block provides faster onset of anaesthesia, produces predictable, consistent dense anaesthesia of all of the fingers with the help of single injection prick.Keywords: Volar digital block, dorsal digital block, local anaesthesia


McCartney CJ, Brull R, Chan VW, Katz j, Abbas S, Graham B, et al. Early but no long-term benefit of regional compared with general anesthesia for ambulatory hand surgery. Anesthesiol 2004;101:461–7.

Klein SM, Evans H, Nielson KC, Tucker MS, Warner DS, Steel SM. Peripheral nerve block techniques for ambulatory surgery. Anesth Analg 2005;101:1663–76.

Ramamurthy S, Anderson D. Anesthesia. In: Green DP, Hotchkiss RN, Pederson WC, Wolfe S, editors. Green's operative hand surgery. Pennsylvania: Churchill Livingstone, 2005;p.25–52.

Scarff CE, Scarff CW. Digital nerve blocks: more gain with less pain. Australas J Dermatol 2007;48:60–1.

Yin ZG, Zhang JB, Kan SL, Wang P. A comparison of traditional digital block and single subcutaneous palmer injection blocks at the base of finger and a meta analysis of digital block trials. J Hand Surg Br 2006;31(5):547–55.

Uysal A, Uysal AC. Comparison of transthecal digital block and traditional digital block for anesthesia of the finger. Plast Reconstr Surg 2006;117(3):1047–8.

Williams JG, Lalonde DH. Randomized comparison of single injection volar subcutaneous block and the two injections dorsal block for digital anesthesia. Plast Reconstr Surg 2006;118(5):1195–200.

Hung VS, Bodavula VK, Dubin NH. Digital anesthesia: comparison of the efficacy and pain associated with three digital nerve block techniques. J Hand Surg Br 2005;30(6):581–4.

Bashir MM, Khan FA, Afzal S, Khan BA. Comparison of traditional two injections dorsal digital block with volar block. J Coll Physicians Surg Pak 2008;18(12):768–70.

Bhatti AZ. Painless method of digital block. Plast Reconstr Surg 2007;119(1):444–5.

Achar S, Kundu S. Principles of Office Anesthesia: Part I. Infiltrative Anesthesia. Am Fam Physician 2002;66:91–4.

Mysore V, Nischal KC. Recommendations: Guidelines for administration of local anesthesia for dermatosurgery and cosmetic dermatology procedures. Indian J Dermatol Venereol Leprol 2009;75(Suppl 2):S68–S75.

Keramidas EG, Rodopoulou SG, Tsoutsos D, Miller G, Ioannovich J. Comparison of transthecal digital block and traditional digital block for anesthesia of the finger. Plast Reconstr Surg 2004;114:1131–4.

Harbison S. "Transthecal digital block: flexor tendon sheath used for anaesthetic infusion". J Hand Surg Am 1991;16:957.

Knoop K, Trott A, Syverud S. Comparison of digital versus metacarpal blocks for repair of finger injuries. Ann Emerg Med. 1994;23(6):1296-300



Most read articles by the same author(s)

1 2 3 > >>