Rama Selvam Paramaswamy
BACKGROUND To know the efficacy of a safe and simple digital block for anaesthesia in A&E for suturing in finger lacerations and other minor finger surgeries that need not require hospital stay and surgery can be done at the earliest. MATERIALS AND METHODS After getting ethical committee approval, and written consent from the patients this study was carried out with the help of the Plastic surgery department and Casualty (A&E) of ACS Medical College and hospital from May 2015 to May 2018. Patients aged 16 to 80 years with finger lacerations were enrolled. After standard wound preparation and lignocaine test dose, all wounds, lacerations were randomized to anaesthesia with digital infiltration of 1% lignocaine. Pain of needle insertion, anaesthetic infiltration, and suturing were recorded on a validated 100-mm Visual Analog Scale (VAS) from 0 (none) to 10(worst); also recorded were percentage of patients requiring rescue anaesthesia; time until anaesthesia; percentage of wounds with infection or numbness at day 7. A sample of 100 patients were selected who were able to detect a 15-mm difference in pain scores. RESULTS 100 patients aged 16 to 76 years of age were given digital block in the minor OT in casualty which had all back up for GA and any emergency. Mean age (SD) was 38.1 (16.8) years, 29% were female. Only one patient in the digital anaesthesia group required rescue anaesthesia. Not only single injection digital block is equally effective in delivering anaesthesia but also in a single injection making it less invasive, easier to perform and teach, and avoids the risk of damaging the finger nerves. All the patients were discharged from hospital from as early as 6 hours to maximum 3 days and followed thoroughly. CONCLUSION Intrathecal single digital block of fingertip injuries to all wounds results in similar pain of needle insertion, anaesthetic infiltration, and pain of suturing.
