Iranian Journal of Orthopedic Surgery

Abstract Abstract
The brachial plexus block is a regional anesthesia technique primarily used for upper limb surgeries. This method involves injecting local anesthetics near the brachial plexus, a network of nerves that innervate the arm, temporarily blocking sensation and motor function in the affected area. It serves as an alternative or adjunct to general anesthesia, particularly benefiting patients with significant comorbidities or those at risk of complications associated with general anesthesia. Regional anesthesia plays a crucial role in orthopedic and outpatient anesthesia advancements by providing both intraoperative anesthesia and postoperative analgesia. Furthermore, with the advent of ultrasound technology, newer upper limb block techniques have been introduced for targeted anesthesia. These various approaches allow anesthesiologists to tailor pain management strategies based on the individual needs of patients and surgical requirements. Continuous improvements in ultrasound technology have enhanced the safety and efficacy of these blocks, making regional anesthesia a standard technique for pain management in upper limb surgeries.

Abstract Background: Finger injuries are very common and the majority can be treated under digital block anesthesia. Traditional digital block is one of the most commonly blocks performed by care providers in several medical fields. There is another less known method, Transthecal (Pulley) block, in which local anesthesia is injected into the flexor tendon sheat. This manuscript compares the effectivenss of these two techniques.Methods: A prospective randomized clinical trial was performed comparing Transthecal pulley block with digital block anesthesia in terms of length of achieved anesthesia and possible need for supplemental anesthesia. 100 consecutive patients who required surgery for their finger injuries randomly received Traditional digital block or Transthecal pulley block. The achieved finger anesthesia was assessed in terms of time and need for additional medication.Results: The mean achieved anesthesia was 34.2 minutes in Transthecal and 33.8 minutes in digital blocks. A repeat infiltration of local anesthesia became necessary in 5 instances in the Traditional digital block and none in Transthecal technique.Conclusions: Because of fewer needs for repeat local anesthetic injection, and lesser risk of neurovascular bundle damage, Transthecal block is suggested as a more suitable local block for finger surgery.