Indications

• Fracture or dislocation reduction of a finger or toe

• Laceration repair of a finger or toe

• Nail procedure of a finger or toe

• Significant wound care/debridement

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My Usual Injection

• 10 mL syringe

• 8 mL 1% lidocaine without epinephrine

• 25g 1 1/2  or 1 5/8in needle

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Procedure

1. Obtain, at least, verbal consent for procedure

2. Palpate and identify the injection sites, which should be at or just distal to each side of the affected phalanx metacarpal (or metatarsal) phalangeal joint, dorsally

3. Apply topical antibacterial to the site x 3, including the interdigital webspace and palmar side of the joint 

4. Apply gloves, if not already done

5. Apply topical analgesic, if desired

6. Place one or two finger of the hand that you are not injecting with on the palmar side of the MP joint that you will be injecting

7. Slowly and controlled, insert needle through skin at previously identified injection site and begin slowly pushing plunger, as you advance needle through toward the palm. 

8. Once you feel the fluid being injected with your fingers on the palm side of the joint, STOP advancing and injecting, as not to penetrate the palmar skin.  Approximately, half of the anesthetic should be injected on each side of the joint.

9. Repeat steps 5 through 9 on the other side of the joint

10. Wipe clean

11. Apply bandage

12. Wait for anesthetic effect before beginning further procedure

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