Finger abscesses, paronychia, and felons are exquisitely painful. Injecting an inflamed finger from multiple angles makes it worse. The transthecal digital block solves this with a single injection and a landmark anyone can find in seconds.
The technique is simple. Identify the volar crease at the metacarpophalangeal joint. Wipe with alcohol or betadine. Use a 27 gauge half-inch needle and enter at 45 degrees. Advance until you touch bone, withdraw a hair, aspirate to confirm you are not in a vessel, and inject 3 to 4 mL of anesthetic. Done.
A few myths worth retiring. Epinephrine in fingers is safe. The fingers, nose, penis, and toes rule has been debunked in the literature. Lidocaine with epinephrine gives better hemostasis and longer anesthesia. Use it.
Reserve the two-stick technique for the rare case where transthecal does not take. Most of the time, one stick is all you need.
Module 2 of The Abscess Course covers the transthecal block on cadaver demonstration, plus facial nerve blocks for external facial abscesses and infected lip piercings.
Full course at: https://www.ebmedicine.net/the-abscess-course
Sincerely,
Dr. Patrick O’Malley
The Abscess Course & The Laceration Course, Course Director
Patrick O’Malley is an emergency physician and course director of The Laceration Course and The Abscess Course. Follow him bellow for more…
