Emergency Department, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands.
Emergency Department, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ 's Hertogenbosch, The Netherlands.
Injury. 2021 Apr;52(4):883-888. doi: 10.1016/j.injury.2021.03.005. Epub 2021 Mar 5.
To identify the most comfortable digital nerve block by comparing painfulness and efficiency of two commonly used digital nerve blocks: the volar subcutaneous nerve block and the traditional dorsal nerve block.
Patients, age ≥ 18 years, presenting with an injury of the finger requiring regional anaesthesia were included. Patients were blindly randomized in receiving the one-injection subcutaneous volar nerve block (intervention group) or the two-injection traditional dorsal digital nerve block (control group). Primary outcome measure was discomfort of the injection. Secondary outcome measures were extent of anaesthesia in different regions of the finger, complication rate and satisfaction of the clinician.
In total, 409 patients were randomly allocated to the intervention group (N=209) or control group (N=200). Discomfort of the injection was not different between both anaesthetic techniques. The mean pain score (Numerical Rating Scale - NRS) of the intervention group was 4.57 (range 0 - 9, CI 4.27 - 4.87, SD 2.18). The mean pain scores of the control group were 4.63 for the first injection (range 0 - 10; CI 4.28 - 4.99, SD 2.36) and 4.51 for the second injection (range 0 - 10; CI 4.14 - 4.87, SD 2.44). The traditional dorsal digital nerve block was better in anesthetizing the dorsal side of the finger. The subcutaneous volar nerve block was better or equivalent in terms of extent of anaesthesia on the volar side of the finger.
In patients requiring digital anaesthesia in the Emergency Department, the anaesthetic technique affects both the discomfort of the injection and extent of anaesthesia. The traditional dorsal digital nerve block is preferred for dorsal injuries. The subcutaneous volar nerve block is preferred for volar injuries.
通过比较两种常用的指神经阻滞方法（掌侧皮下神经阻滞和传统背侧神经阻滞）的疼痛程度和效果，确定最舒适的指神经阻滞方法。
纳入年龄≥18 岁、因手指损伤需行区域麻醉的患者。患者盲法随机分为单次注射掌侧皮下神经阻滞（干预组）或两次注射传统背侧指神经阻滞（对照组）。主要观察指标为注射时的不适感。次要观察指标为手指不同区域的麻醉范围、并发症发生率和临床医生的满意度。
共纳入 409 例患者，随机分配至干预组（n=209）或对照组（n=200）。两种麻醉技术的注射不适感无差异。干预组平均疼痛评分（数字评分量表-NRS）为 4.57（范围 0-9，CI 4.27-4.87，SD 2.18）。对照组第一次注射的平均疼痛评分为 4.63（范围 0-10；CI 4.28-4.99，SD 2.36），第二次注射的平均疼痛评分为 4.51（范围 0-10；CI 4.14-4.87，SD 2.44）。传统背侧指神经阻滞在麻醉手指背侧方面效果更好，而掌侧皮下神经阻滞在麻醉手指掌侧方面的效果更好或相当。
在急诊科需要手指麻醉的患者中，麻醉技术既影响注射时的不适感，又影响麻醉范围。传统背侧指神经阻滞适用于背侧损伤，掌侧皮下神经阻滞适用于掌侧损伤。
