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Just a quick question

When testing L.A, would you expect the matrix area to be one of the first areas to go or one of the last?

I think you might need to carify what you are asking??

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Joke yes?

Using a digital block i) the digit will be anaesthetised, ii) the question is irrelevant.

ok, if a digital block fails to take, is there any particular area of the digit that it is more likely to occur in?

recently one of my fellow pods commented that when an L.A fails to take completely for them, it is often at the apex of the digit , I have noted that it usually the matrix area.

I ask simply out of curiosity, if does not matter, then thats fine, I was just interested to know!

I have had it happen to me in both places. I think it is just luck most of the time!!! (now I just sound dodgy!!!! lol)

This I feel is not an irrelevant question and the problem is common.
You will probably find you are injecting too much into the dorsal digital N area and not enough into the areas of the plantar digital nerve as it is these that supply the apex and nail bed.
Check your dermatomes for the toe, it is in one of the Pod books as I remember this from Uni.

Thank you for taking the time to respond

I felt that branding the question "irrelevant" was a little harsh on the part of Mr Liggins, If it is of no interest to you, then I would prefer no response as opposed to the one he gave.

prehaps he would care to enlighten me as to why he thinks it is so?


kind regards

I'm sure Bill can answer for himself, but I tend to agree with him insomuch as if a digital block fails to take it is either because the technique is poor or you are injecting a digit where there is a substantive tissue infection present - which, of course, is contraindicated in any case. Partial digital blocks often fail to sufficiently anaesthetise the apex of the digit as sensory input is more often than not carried by the opposing digital nerves, especially the medial plantar nerve, and this should be considered prior to carrying out the necessary procedure. Good technique combined with adequate knowledge of cutaneous innervation is essential for competent analgesia.

Regards

Mark Russell

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"citing an indisposition due to special circumstances"

My location

Thank you for giving me the opportunity to reply.

Essentially, the situation was covered by my first answer and reaffirmed by Mark Russell. The question, IMO, is irrelevant because if the digital block fails to be effective, then the procedure cannot take place.
If anyone wishes to carry out research into the precise innervation of precise areas in a digit, then fair enough. However, I think that the design would be extremely difficult, ethically complex, and the results yielded would have no direct clinical application.

Mark is, I am sure, correct. A proper knowledge of anatomy, allied to correct technique will result in an appropriate anaesthetic result; not a matter of 'luck'. If intially the block fails, then simply 'top up'.

Kind regards

Bill Liggins

Thank you for the response gentlemen

As I said, it was just something my colleague & I were mulling over during a rare gap in our clinical sessions

kind regards