Anesthesia/Analgesia

  • Digital Nerve Block
  • Local Anesthesia (General)
  • Occipital Nerve Block
  • Sphenopalatine Ganglion Block
  • Trigger Point Injection

Digital Nerve Block

  • Background
    • Injection of local anesthetic into the base of the finger or toe to accomplish regional anesthesia. 
  • Indications
    • Laceration repair, nail trephination, dislocation/fracture reduction, paronychia/felon.
  • Contraindications
    • Distortion of landmarks, overlying skin infection
  • Complications
    • Unintentional intravascular injection, bleeding, infection
Video Credit: Core EM

*Deep Dive: Trick of the Trade: Single Digital Block (ALiEM)



Local Anesthesia (General)

  • Background
    • Direct injection of local anesthetics (lidocaine, bupivacaine, etc.) into the tissues to block transmission of impulses in nerve fibers and provide a temporary loss of sensation, generally for the purposes of reducing pain for further surgical intervention.
  • Indications
    • For anesthesia prior to wound closure, incision/drainage, or other painful procedures. 
  • Contraindications
    • Allergies to anesthetic agent
  • Complications
    • Unintentional intravenous injection, pain/discomfort, infection
Video Credit: MiniMedLessons

*Deep Dive: How To Do Local Wound Infiltration (Merck Manual)



Occipital Nerve Block

  • Background
    • Injection of local anesthetic along the greater and lesser occipital nerves. 
  • Indications
    • Migraine (refractory to conservative treatment), cluster headache, occipital neuralgia, cervicogenic headache
  • Contraindications
    • Overlying skin infection at injection site
  • Complications
    • Rare, but include bleeding, infection, and damage to surrounding structures
Video Credit: CHA Communications

*Deep Dive: ED Migraine Management – The New Kid on the “Block” (emDocs)



Sphenopalatine Ganglion Block

  • Background
    • Application of local anesthetic to the sphenopalatine ganglion located behind the nose. 
  • Indications
    • Acute cluster headaches, migraine, trigeminal neuralgia, herpes zoster neuralgia
  • Contraindications
    • Allergy to anesthetic, infection within intranasal canal, altered patient.
  • Complications
    • Bleeding, infection, epistaxis
Video Credit: ALiEM

*Deep Dive: Tickle Your Brain to Numb the Pain: EM Use of Sphenopalatine Ganglion Block for Migraine Headaches (EMRA)



Trigger Point Injection

  • Background
    • Injection of local anesthetic into area of focal, hyper-irritated muscle spasm for pain relief.
  • Indications
    • Focal, reproducible pain with movement/palpation in a defined, accessible location.
  • Contraindications
    • Allergy to anesthetic, overlying skin infection, coagulopathy/bleeding disorder
  • Complications
    • Bleeding, infection, pain
Video Credit: Larry Mellick

*Deep Dive: Trigger Point Injection for Musculoskeletal Pain in the ED (ALiEM)


Brandon Simpson, PA-S2
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