[Single Subcutaneous Palmar Injection vs. 2 Dorsal Injections for Finger Anaesthesia in Hand Surgery - Randomised Prospective Comparison of Application Pain and Efficacy]

Comparison of the effectiveness of local anesthesia for the digital block between single-volar subcutaneous and double-dorsal finger injections: a systematic review and meta-analysis of randomized control trials

Local anesthesia is an effective method to perform digital nerve blocks. In this study, we compare the effectiveness of single-volar subcutaneous and double-dorsal injection through a systematic review and meta-analysis of randomized controlled trials (RCTs). A systematic search of PubMed, Embase, and the Cochrane Library from inception to 7 April 2021 was performed. RCTs with the effects of single-volar subcutaneous and double-dorsal injection were eligible. Meta-analysis was performed using random effect models with pooled standardized mean differences (SMDs) and 95% confidence intervals (CI). RoB 2.0 and GRADE of Recommendation Assessment, Development, and Evaluation criteria were applied for evaluating the bias. A total of 2484 studies were initially identified, with 11 eligible RCTs finally included in the meta-analysis (1363 patients). The pooled data of nine studies showed single-volar injection had a statistically significantly lower pain score (pooled SMD: 0.20, 95% CI, 0.01 to 0.39, p = 0.041, I2 = 58%, N = 1187) and higher patient preference but invalid anesthesia at the dorsal proximal digit. No significant differences were observed in the onset of anesthesia, adjacent digit invalid numbness, distal phalanx invalid anesthesia, additional injection rate, and adverse effects. In conclusion, this meta-analysis of RCTs showed that the single-volar injection was associated with a lower pain sensation during injection and higher patient satisfaction with a reduced anesthetic effect over the proximal dorsal phalanx. Further high-quality RCTs with a higher number of cases are needed to validate our results.

Clinical application of ultrasound-guided selective proximal and distal brachial plexus block in rapid rehabilitation surgery for hand trauma

BACKGROUND

Anesthesia plays an essential role in the successful surgical procedures for hand trauma. Compared with general anesthesia, brachial plexus block shows lots of benefits for the upper extremity. Specifically, ultrasound-guided selective proximal and distal brachial plexus block may overcome the issues of incomplete block and failure of anesthesia in such circumstances. The present study assessed the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in clinical practice.

AIM

To explore the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in rapid recovery surgery for hand trauma.

METHODS

A total of 68 patients with traumatic hand injuries treated at our hospital from January 2018 to June 2019 were selected. They were divided into an observation group and a control group with 34 patients in each group. The observation group underwent selective brachial plexus block guided by ultrasound and the control group underwent conventional brachial plexus block. The analgesic efficacy, intraoperative complications, wound healing time, and length of hospital stay were compared between the two groups under different anesthesia.

RESULTS

The percentage of cases with analgesia graded as “excellent or very good” was higher in the observation group than in the control group (P < 0.05). Moreover, the incidence of intraoperative complications was lower and the wound healing time and length of hospital stay were shorter in the observation group than in the control group (P < 0.05).

CONCLUSION

Ultrasound-guided selective proximal and distal brachial plexus block has remarkable analgesic efficacy in patients with traumatic hand injuries. It can reduce the incidence of intraoperative complications, promote wound healing, and shorten the length of hospital stay.

[Oberst's block anesthesia]

OBJECTIVE

Complete anesthesia of the phalanges of the fingers and toes.

INDICATIONS

All lesions distal to the metacarpophalangeal/metatarsophalangeal joint.

CONTRAINDICATIONS

Local infections at the injection site. Lesions proximal to the metacarpophalangeal/metatarsophalangeal joint.

TECHNIQUE

A subcutaneous deposit of a 0.5-2% local anesthetic is administered dorsoradially and dorsoulnarly at the base of the metacarpophalangeal/metatarsophalangeal joint. With the cannula advanced to palmar, an additional 0.5-1.5 ml is then administered to achieve complete anesthesia.

POSTOPERATIVE MANAGEMENT

The effect of the local anesthesia is self-limiting.

RESULTS

The Oberst block results in reliable anesthesia of the finger and toe. All surgical procedures distal to the metacarpophalangeal/metatarsophalangeal joint can be performed without pain.