Paper Chosen by: Chris Connolly
Clinical Question: In patients with finger injuries, does a single volar injection provide as good analgesia as ‘ring block’ double injection technique?
1st Author: Martin
Journal: Emergency Medicine Australasia
Title: Double-dorsal versus single-volar digital subcutaneous anaesthetic injection for finger injuries in the emergency
department: A randomised controlled trial
Patients studied: Adults presenting to ED requiring a digital nerve block,. 86 ptients randomised. intention to treat analysis. power ‘estimated’ (i think) to a 10mm difference in pain score
Intervention: Single volar SC injection of 2-3ml 1%lidocaine just distal to the mcpj crease
Comparison: standard’ double dorsal injection with 1ml each side.
Outcomes: Primary outcome measure was the pain associated with the injection, secondary outcome was pain associated with the injury 5mins post injection and success of the injection.
Strengths: power calculation done. allocation concealment undertaken. intention to treat analysis undertaken.
Weaknesses: no attempt to blind the pain assessor to the technique performed. more likely beneficial or useful to know if the injection is as successful or even better than single site injection.
Clinical bottom line: There’s no difference in pain form injection of single site injection for finger injuries, this was not powered to detect a difference in injury associated pain scores.