Article Text

Download PDFPDF
Comparative anatomical study of digital block with the WALANT, interdigital, and transthecal techniques
  1. Lorena Morales1,
  2. Pierre Goffin1,2,
  3. Enrique Jorcano3,
  4. Miguel Angel Reina4 and
  5. Xavier Sala-Blanch5,6
  1. 1Advanced Medical Competences, Regional Anesthesia Based on Human Anatomy, University of Barcelona, Barcelona, Spain
  2. 2Anesthesia and Intensive Care, CHC de Liège, Liège, Belgium
  3. 3Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
  4. 4Department of Anesthesiology, CEU San Pablo University Faculty of Medicine, Madrid, Spain
  5. 5Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain
  6. 6Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
  1. Correspondence to Dr Xavier Sala-Blanch, Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain; xavi.sala.blanch{at}


Introduction Interdigital block and transthecal block through the flexor sheath are commonly used techniques for the anesthesia of isolated fingers. The wide-awake local anesthetic no-tourniquet technique is a relatively new approach for local anesthesia during finger procedures. The anatomical spread of local anesthetics with the wide-awake local anesthetic no tourniquet technique has not been described adequately.

This anatomical study aimed to assess the distribution of a local anesthetic dye solution to the digital nerves. The study was designed to compare the nerve staining effect using the wide-awake local anesthetic no tourniquet and the transthecal and interdigital techniques in cadavers. We hypothesized that the wide-awake local anesthetic no tourniquet technique stains digital nerves more effectively than the interdigital and transthecal digital injection techniques.

Methods 14 blocks were performed using anatomical landmarks. 2 mL of a mixture of local anesthetic, methylene blue, and contrast medium were injected. Before dissection, the specimens were passed through an X-ray scanner to assess the spread of the mixture. Finally, anatomical dissections were performed to evaluate the specific hand nerve implications.

Results In the wide-awake local anesthetic no tourniquet group, the local anesthetics spread to the nerves of each finger but not the common nerve. In the transthecal and interdigital groups, the spread extended from the common nerve to the lateral aspect of the adjacent fingers.

Conclusion The wide-awake local anesthetic no tourniquet technique was as effective as conventional techniques in the digital blockade, achieving specific spread on the targeted nerves.

  • analgesia
  • Upper Extremity
  • Anesthesia, Local

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors LM: Data collection and management, data analysis. PG: Data collection and management, data analysis and manuscript writing and editing. EJ: Data analysis. MAR: Manuscript editing. XS-B: Conceived the concept and designed the study, project development, data analysis, manuscript writing and editing, guarantor. All authors have read and approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.