Double-dorsal Versus Single-volar Digital Block

Double-dorsal Versus Single-volar Digital Subcutaneous Anaesthetic Injection for Finger Injuries in the Emergency Department: A Randomised Controlled Trial

The aim of this study is to compare the traditional dorsal double injection digital block with the palmar single injection technique in the suturing of acute traumatic hand finger lacerations in terms of injection pain score (NRS), anesthesia onset time, and success of anesthesia.

It is understood that single injection digital block and double injection digital block techniques do not have significant advantages over each other in terms of pain levels and procedure times.

However, the need for rescue anesthesia was evaluated to be lower in the single injection digital block technique. This difference is especially due to measurements in the volar region incisions.

According to the results of this study, we think that choosing the single injection digital block technique for volar region incisions is a more rational approach, especially in terms of the data of the need for rescue anesthesia.

Study Overview

• Status: Completed
• Conditions: Pain; Anesthesia, Local; Nerve Block; Laceration of Skin
• Intervention / Treatment: Procedure: Palmar digital block; Procedure: Dorsal digital block

Detailed Description

Randomized, parallel controlled, open labeled experimental study

• Study Type: Interventional
• Enrollment (Actual): 160
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Ankara, Turkey
    • Ankara City Hospital Emergency Medicine Department

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Between 18-65 years of age
• Isolated traumatic acute hand finger lacerations requiring suturing
• Admissions within 6 hours of injury
• Patients who can cooperate with the NRS score
• Patients who gave consent

Exclusion Criteria:

• Vein, nerve and tendon lacerations on the hand that require repair
• Amputation or bone fracture
• Those who have used analgesics in the last 12 hours
• Hemodynamically unstable patients
• Known allergy to prilocaine hydrochloride

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Single injection palmar digital block; The needle was inserted into the subcutaneous region from the palmar side to the root of the proximal phalanx, perpendicular to the frontal plane and the finger. For anesthesia, 3 ml of anesthetic agent (prilocaine hydrochloride) was applied to the described point with this single injection and the needle was slowly removed.	Procedure: Palmar digital block; Palmar regional digital block anesthesia (No drug or device is being investigated here; the two digital block procedures mentioned are compared)
Experimental: Double injection dorsal digital block; The needle was inserted into the proximal dorsal root of the proximal phalanx, into both the medial and lateral parts, perpendicular to the fingers and the frontal plane. After the aspiration, the injection was performed slowly and the needle was withdrawn concurently. A total of 3 ml of anesthetic agent (prilocaine hydrochloride) was injected into both the medial and lateral parts of the finger, 1.5 ml for each side.	Procedure: Dorsal digital block; Dorsal regional digital block anesthesia (No drug or device is being investigated here; the two digital block procedure mentioned are compared)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Anesthesia pain score	Numerical rating scale (NRS): 0 to 10 (min-max); higher scores indicates more pain	3rd minute

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Anesthesia onset time	Time achieved to total anesthesia	Measurements are provided per 30 seconds (30-60-90-120 seconds and more if necessary)

Collaborators and Investigators

• Sponsor: Ankara City Hospital Bilkent
• Investigators: Principal Investigator: Alp Şener, Assoc prof, Ankara Yıldırım Beyazıt University Faculty of Medicine

Study record dates

Study Major Dates

• Study Start (Actual): October 12, 2022
• Primary Completion (Actual): July 12, 2023
• Study Completion (Actual): September 12, 2023

Study Registration Dates

• First Submitted: February 8, 2024
• First Submitted That Met QC Criteria: February 15, 2024
• First Posted (Actual): February 23, 2024

Study Record Updates

• Last Update Posted (Actual): February 23, 2024
• Last Update Submitted That Met QC Criteria: February 15, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: Pain; Digital nerve block; Finger lacerations; Single palmar injection; Double dorsal injection
• Additional Relevant MeSH Terms: Wounds and Injuries; Lacerations
• Other Study ID Numbers: E2-22-2566

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No