Special Operations Forces Medical Handbook

5-163

of the digit.

6. Slowly inject the medication with the smallest possible gauge needle to minimize pain.


7. Repeat steps 4-7 for the palm

What Not To Do:
Contraindications:

1. Avoid local anesthetics in patients reporting allergies to them.


2. Avoid using vasoconstrictors with these blocks.

Complications: Tissue ischemia and necrosis. Large volumes of local anesthetics can lead to mechanical
compression and ischemia. Deposit the anesthetic only on the lateral aspects of the digits to be anesthetized.
Avoid total circumferential administration.

Table 5-14: Anesthetics for Digital Blocks

Plain Solutions
Drug Concentration Maximum Dose Duration
(%) (milligrams) (minutes)
Lidocaine 0.5 - 1.0 300 30 - 60
Prilocaine 0.5 - 1.0 500 30 - 90
Bupivacaine 0.25 - 0.5 175 120 - 240

III. Standard Approach To Blocks

a. For the rest of this section, the following equipment will be referred to as Standard Equipment in the
What you Need paragraph: An antiseptic prepping solution (Betadine or alcohol), appropriate sized

Injection between metatarsal bones

Metatarsal Block

Figure 5-32