One of the most important aspects of performing any surgical procedure is the ability to achieve appropriate anesthesia. During my first few years in practice, I tried a variety of techniques attempting to discover the most efficient, painless way to perform a complete digital block.
If you will follow these steps, I am confident that you to will get great results.
1. Apply a topical preparation to the site of the digit that you will be placing the injection. I use this compounded topical (Benzocaine 20%, Lidocaine 6%, Tetracaine 4%) Allow the topical to stay in place for at least 15 minutes prior to the injection, although optimal time would be 30 minutes.
2. Mix 2.5cc of 1% Lidocaine Plain with 2.5cc of 0.5% Marcaine Plain and add 0.2cc-0.4cc of 8.4% Sodium Bicarbonate (helps decrease the stinging sensation with the injection). Don't use to much Sodium Bicarbonate, as this will decrease the effectiveness of the anesthetic.
3. Clean the application site with alcohol.
4. Spray the injection site with a 'cold freeze' topical spray (see my blog post on 'Placing a Plantar Fascial Injection for a link to the product that I use)
5. Inject approximately 1 1/4cc of the mixture into all 4 areas around the digit. You will essentially be making a ring of anesthesia around the digit of choice.
Check out my Demonstration Video
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