What is the three-sided digital nerve block technique?

Updated: May 16, 2018
  • Author: Dmitry Volfson, DO; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Answer

This type of digital block is effective in anesthetizing the great toe, but it can be used for any digit.

  • Place the patient’s extremity volar/plantar side down.

  • Insert the needle at a 90-degree angle at the medial aspect of the digit, just distal to the metatarsal-phalangeal joint (see image below).

    Medial injection for 3-sided digital block. Medial injection for 3-sided digital block.
  • Slowly inject the anesthetic as the needle is advanced toward the volar/plantar side, without piercing the volar skin.

  • Slowly withdraw the needle and redirect it medially.

  • Advance the needle slowly from medial to lateral side while the anesthetic is injected (see image below).

    Medial to lateral injection for 3-sided digital bl Medial to lateral injection for 3-sided digital block.
  • Withdraw the needle.

  • Make another injection over the already anesthetized skin at the lateral aspect of the digit, with the needle at 90 degrees, advancing it from the dorsal to ventral aspect, as was done medially (see image below).

    Lateral injection for 3-sided digital block. Lateral injection for 3-sided digital block.

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