Emergency Department, Queen Alexandra Hospital, Portsmouth, UK
Emerg Med J. 2010 Jul;27(7):533-6. doi: 10.1136/emj.2009.072850. Epub 2010 Apr 1.
Digital nerve blocks (DNB) are performed frequently in the Emergency Department (ED). The aim of this study was to establish whether single injection subcutaneous digital nerve block (SDNB) is as effective as the traditional (two injection) digital nerve block (TDNB) for digital anaesthesia.
Single blinded, prospective, randomised-controlled multicentre trial within Hampshire EDs. Patients > or = 16 years attending the ED with fingertip injuries/infections (distal to the distal-interphalangeal joint) requiring a DNB were randomised to SDNB/TDNB groups. Outcome measures were: primary - successful anaesthesia; secondary - patient distress, clinician satisfaction (CS), complications.
76 patients were randomised. (37 received SDNB). At 5 min, more patients in the SDNB group (28/37, 76%) were adequately anaesthetised than in the TDNB group, (22/34, 65%). At 10 min, 33/37 (89%) of the SDNB group compared to 28/34 (82%) of the TDNB group were adequately anaesthetised. The mean (SD) of self-reported distress scores for the SDNB group were lower than those reported for the TDNB group, whereas the mean (SD) of CS scores for SDNB were higher than those reported for TDNB. Neither group reported complications from anaesthesia.
SDNB is as effective as TDNB. Outcome measures favoured SDNB, but only CS scores achieved statistical significance. Trial recruitment is much slower than anticipated. However, clinical practice has demonstrated that SDNB works and practice is already changing within the Hampshire region, with some departments adopting SDNB as standard practice. Therefore, the results are being presented now to allow clinicians to make an informed choice. Our results may also contribute to future metanalyses.
在急诊部（ED）经常进行数字神经阻滞（DNB）。本研究的目的是确定单次皮下注射数字神经阻滞（SDNB）是否与传统（两次注射）数字神经阻滞（TDNB）一样有效用于数字麻醉。
在汉普郡 ED 中进行单盲、前瞻性、随机对照多中心试验。患有指尖损伤/感染（远侧指间关节以下）需要 DNB 的年龄大于或等于 16 岁的患者被随机分配到 SDNB/TDNB 组。主要观察指标：成功麻醉；次要观察指标：患者痛苦、临床医生满意度（CS）、并发症。
76 例患者随机分组。（37 例接受 SDNB）。在 5 分钟时，SDNB 组（28/37，76%）有更多的患者麻醉充分，而 TDNB 组（22/34，65%）有更多的患者麻醉充分。在 10 分钟时，SDNB 组（33/37，89%）与 TDNB 组（28/34，82%）相比，有更多的患者麻醉充分。SDNB 组自我报告的痛苦评分平均值（SD）低于 TDNB 组，而 SDNB 组的 CS 评分平均值（SD）高于 TDNB 组。两组均未报告麻醉相关并发症。
SDNB 与 TDNB 一样有效。结局指标对 SDNB 有利，但只有 CS 评分具有统计学意义。试验招募比预期的要慢。然而，临床实践已经证明 SDNB 有效，汉普郡地区的一些部门已经将 SDNB 作为标准实践。因此，现在公布结果是为了让临床医生做出明智的选择。我们的结果也可能对未来的荟萃分析有所贡献。
