None listed
Conditions
Brief summary
Patients with finger injuries often require their finger to be numb to allow their injury to be assessed properly and treated. There are several methods available to numb the finger. Our study aims to compare two methods for numbing the patient’s finger to see which one of these methods is least painful for the patient. The first method is a single injection in the palm of the hand and the second method is two injections in the back of the hand or finger. The second method is the most commonly used method in our emergency department. Our hypothesis is that the single injection into the palm is less painful than the double injection in the back of the hand or finger. Patients who present to the emergency department with finger injuries that require their finger to be numb for treatment or assessment of their injury will be given a study information sheet and consent will be obtained for participation in the study. Participants will then be randomly assigned to receive either the single injection in the palm or the double injection in the back of the hand or finger. A medical officer will perform the injection to numb the finger and a separate medical officer will then ask the patients to rate the pain of the injection to numb their finger. Participants will also be asked to rate their pain level before and five and ten minutes after the injection. The patient’s finger injuries will be treated as per standard care for their injury. Patients will be contacted at one week following the injection to ask them if they have any pain or signs of infection such as redness or swelling.
Interventions
The intervention group will receive a palmar subcutaneous injection at the level of the first annular pulley of the flexor tendon as outlined by Myers, ASEM 2011; www.myhand.com.au)
(1) Aseptic injection technique
(2) Surface markings used are the junction of the line joining the two palmar creases and another line over the flexor sheath of each finger.
(3) A 3.75-cm, 25 gauge needle inserted subcutaneously above the tendon sheath.
(4) Avoid injection into crease
(5) Patient is asked to move t
The intervention group will receive a palmar subcutaneous injection at the level of the first annular pulley of the flexor tendon as outlined by Myers, ASEM 2011; www.myhand.com.au) (1) Aseptic injection technique (2) Surface markings used are the junction of the line joining the two palmar creases and another line over the flexor sheath of each finger. (3) A 3.75-cm, 25 gauge needle inserted subcutaneously above the tendon sheath. (4) Avoid injection into crease (5) Patient is asked to move their finger to determine if the needle is in the tendon sheath. If the needle moves then the needle is in the tendon. The needle is then pulled back 1mm and retested until needle is in a subcutaneous location (6) Inject 3mls of lignocaine 1% without adrenaline (7) Massage local anaesthetic to encourage dorsal (8) If proximal dorsal anaesthesia not provided by above technique and is required a single subcutaneous injection over extensor tendon sheath may be used (9) Anaesthesia tested after 5 minutes (10) If anaesthesia is not adequate for procedure then subsequent repeat anaesthetic injection will be required. This will be up to the treating clinician to perform either a single injection in the back of the hand in the skin overlying over the extensor tendon or a double injection digital nerve block.
Sponsors
Royal Brisbane and Womens Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients will be included if they 1. are aged >= 18 years old and 2. present with a finger injury requiring digital anaesthesia
Exclusion criteria
Patients will be excluded if they: 1. Have a digital nerve injury proximal to distal interphalangeal joint. Such patients are excluded because assessment of the distal sensation of the finger is performed by the hand surgical team as these injuries benefit from operative intervention. 2. Have peripheral neuropathy or vasculopathy. Peripheral neuropathy will confound the assessment of pain of the injection and all pain scores. Vasculopathy will result in reduced blood flow to the digit and may result in increased risk vascular compromise following digital anaesthesia. 3. Are unwilling or unable to consent. This includes patients with a psychotic illness that would impair their ability to consent and patients with alcohol or drug intoxication. 4. Have a tendon sheath infection as digital nerve block may promote the spread of the infection 5. Skin disease such as eczema overlying the injection site 6. Have an allergy to lignocaine
Outcome results
None listed