Ultrasound-guided flexor sheath block as a valid alternative to blind techniques for finger pain treatment: the horseshoe sign.

Abstract

BACKGROUND:

The flexor sheath digital block allows effective analgesia and anesthesia for finger pain control. To date, only blind techniques are described in the literature in patients with finger fractures, supposedly due to the superficial position of the structures used as landmarks. We describe an ultrasound-guided technique with a definite endpoint to achieve this block. To our knowledge, this is the first clinical application of this procedure.

METHODS:

We performed a preoperative ultrasound-guided flexor sheath digital block on a young patient with a proximal phalanx fracture, undergoing an osteotomy with plate placement. After performing the block, opioid-free general anesthesia was performed. A "hockey-stick" ultrasound probe and 1.5 mL of 0.5% levobupivacaine were used to infiltrate the flexor sheath. The "horseshoe sign" was our visual endpoint for successful block performance.

RESULTS:

At the time of surgical incision, there was no hemodynamic response. No opioids were administered during the case or in the recovery room, and the patient's pain scores in recovery and at discharge were 0/10 on the Numerical Rating Scale. No complications were observed or reported.

CONCLUSIONS:

The ultrasound-guided flexor digital sheath block is a valid alternative to the blind technique, allowing direct visualization and, thereby, confirming transthecal injection of the local anesthetic. The continuously increasing availability of ultrasound machines in emergency departments and operating theaters may encourage the spread of this technique.

• Authors: Antonio Fioccola, Conor John Skerritt
• Journal: Regional anesthesia and pain medicine (Reg Anesth Pain Med) Vol. 48 Issue 7 Pg. 375-377 (07 2023) ISSN: 1532-8651 [Electronic] England
• PMID: 36918229 (Publication Type: Journal Article)
• Copyright: © American Society of Regional Anesthesia & Pain Medicine 2023. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Anesthetics, Local
• Analgesics, Opioid

Topics

• Humans
• Nerve Block (methods)
• Ultrasonography, Interventional (methods)
• Anesthetics, Local
• Pain
• Anesthesia, Local (methods)
• Analgesics, Opioid
• Pain, Postoperative (diagnosis)