Digital nerve block is a quick and effective method to provide anaesthesia for injuries and procedures to the digits. This is a useful skill for any doctor working in the emergency department. This article will cover the relevant anatomy, indications, complications and technique to perform this procedure.

Sensation to the dorsal and palmar aspects of the digits is supplied by branches of the median, ulnar and radial nerves. Each digit is innervated by 2 pairs of dorsal and palmar nerves with one running on each side of the digit (see image below). Anaesthetic must be administered to all 4 nerves to achieve analgesia of the entire digit. The dorsal nerves run at a 10 and 2 o’clock position, while the palmar nerves run at a 8 and 4 o’clock position. Each nerve runs close to a digital artery and vein.

Cross sectional relevant anatomy of a digit with approximate position of injection.

Any situation where analgesia to the digit is required may be appropriate for digital nerve block. The following list is not exhaustive but indications may include:

• Reduction of phalangeal fracture or dislocation
• Drainage of infections of the digit or nail
• Treatment or repair of injuries to the digit or nail
• Removal of foreign body

Digital nerve block is not apprirate in the following situations:

• Infection at or in the path of the injection site
• Allergy to local anaesthetic
• Absence of landmarks needed to guide needle insertion (e.g disfigurement due to trauma)
• Patient refusal

Digital nerve blocks are generally safe and well tolerated but as with all procedures there are risks of complications, including:

• Pain from the procedure or inadequate anaesthesia
• Bleeding
• Infection
• Direct injury to digital nerves
• Vascular injection of local anaesthetic
• Allergic reaction to local anaesthetic

• Small gauge needle (25-27G)
• 5 or 10ml syringe
• Blunt drawing needle
• Anti-septic skin wipes
• Lidocaine 1% (4ml is usually sufficient for adults, max dose 3mg/kg)
• Gloves
• Apron

There are multiple techniques to perform a digital nerve block. This article will cover the dorsal web space approach as it is designed to provide analgesia to the whole digit. Further reading about palmar and thecal approaches are available in the references if wishing to minimise injections or only localised analgesia is required.

1. Explain the procedure, indication and risks to the patient and obtain consent.
2. Draw up 4ml lidocaine 1% and discard the blunt needle in a sharps bin.
3. Position the patient so they are sitting or lying comfortably. Ensure the target hand is resting on a sterile surface with the palm side down.
4. Wash your hands and don gloves and apron.
5. Clean the skin with an anti-septic wipe around the dorsal webspace of the digit you will be injecting and allow to dry.
6. Insert the needle at the dorsal webspace (see image below), perpendicular to the digit. Advance the needle with a slight angle towards the midline of the digit. Stop when the needle is felt on the palmar side but do not puncture the skin.
7. Aspirate the syringe to ensure you are not in a blood vessel.
8. Inject 1ml of lidocaine and then inject a further 1ml whilst withdrawing the needle completely.
9. Repeat steps 5 to 8 on the opposite side of the digit.
10. Dispose of the equipment in the relevant bin ensuring any needles are discarded into a sharps bin and wash your hands.
11. Allow 5 to 10 minutes for the analgesia to take effect.
12. Document the procedure including obtained consent, local anaesthetic given, volumes used and sites of injection.

Further reading:

Napier A, Howell DM, Taylor A. Digital Nerve Block. [Updated 2024 Feb 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526111/

Gottlieb M, Penington A, Schraft E. Digital nerve blocks: a comprehensive review of techniques. The Journal of Emergency Medicine. 2022 Oct 1;63(4):533-40.

Written by Dr Jesse Chan (FY3)