Transthecal Metacarpal Block Versus Traditional Digital Block for Painful Finger Procedures in Children

11:40 EDT 6th July 2015 | BioPortfolio

Summary

The purpose of this study is to determine if the transthecal metacarpal block is superior to the traditional digital block for regional digital anesthesia in children.

Description

Background: Finger injuries and infections are common presenting problems in the pediatric emergency department. A traditional digital block, requiring at least two injections of anesthetic, is the traditional method of regional anesthesia for many finger procedures. Digital blocks can sometimes be difficult to administer and assess for effectiveness especially in children. A newer procedure, the transthecal metacarpal block, may be easier to administer, and more effective with one injection.

Objective: To determine if the transthecal metacarpal block (MCB) provides superior digit anesthesia in children requiring painful finger procedures as compared to the traditional digital block (TDB).

Methods: A randomized clinical trial comparing the MCB to the TDB will be conducted in an urban, tertiary care pediatric emergency department. Children <18 years of age, presenting to the emergency department with a finger injury or infection, which requires regional anesthesia for repair will be screened for eligibility. Eligible patients, with appropriate consent will be randomized to receive either the MCB or TDB with 1% Lidocaine. The primary outcome, success of the block will be assessed using pinprick testing after a standardized wait time. Secondary outcomes including pain with the block and repair, repairing physician satisfaction, and short-term complications will also be assessed.

Implications: Finding successful methods of anesthesia and pain control are paramount in the pediatric emergency department. In addition, using a type of digital block which is easy to administer, successful, and requires only one injection would give physicians confidence to treat finger injuries in children with regional anesthesia and possibly avoid procedural sedation in some cases. To date, no studies have been published on the efficacy of digital blocks in children. This study will also serve to give baseline success rates for both types of digital blocks.

Study Design

Allocation: Randomized, Control: Active Control, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment

Conditions

Finger Injuries

Intervention

Transthecal Metacarpal Block

Location

The Children's Hospital Of Philadelphia Emergency Department
Philadelphia
Pennsylvania
United States
19104

Status

Completed

Source

Children's Hospital of Philadelphia

Results (where available)

View Results

Links

Clinical Trials [316 Associated Clinical Trials listed on BioPortfolio]

Swelling or Malrotation of Metacarpal Shaft Fractures in the Evaluation of Rotational Deformity

Rotational deformity or malunion causes the most significant functional deficit in these common fractures. The evaluation of the rotation may be performed with the metacarpophalangeal join...

Conservative or Operative Treatment of Fractures in the Neck of the 5th Metacarpal Bone

A multi-site randomized controlled trial where patients are allocated to operative treatment or conservative treatment of fractures of the neck of the 5th metacarpal bone. The study goal i...

Conservative Versus Operative Treatment of Displaced Neck Fractures of the Fifth Metacarpal

This is a prospective, randomized, multi-center pilot study of isolated, displaced neck fractures of the fifth metacarpal. The patients are randomly assigned to osteosynthesis with antegra...

Medial Versus Lateral Approach in Ultrasound (US)-Guided Supraclavicular Block

The ultrasound guided supraclavicular block is a peripheral nerve block which is considered safe, has a fast onset, is dense and provides complete block of the nerves supplying the hand, f...

Comparison of Splinting Interventions for Treating Mallet Finger Injuries

Stubbing of the finger-tip is a common injury in sports such as basketball, volleyball, cricket and football. This can result in a Mallet finger deformity, where the end joint of a finger ...

PubMed Articles [3196 Associated PubMed Articles listed on BioPortfolio]

Transposition of the Ring Finger after Severe Hand Injury.

We report a severe hand injury with a fracture of the third metacarpal bone, destruction of the metacarpophalangeal joint of the fourth finger, amputation of the little finger of the right hand and se...

Teletriage for patients with traumatic finger injury directing emergency medical transportation services to appropriate hospitals: A pilot project in Nagoya City, Japan.

Emergency medical technicians in Japan have experienced difficulties in identifying hospitals that will accept patients with severe finger injuries. We developed and managed a system named Interactive...

Reconstruction of a large soft-tissue defect in the single finger using the modified cross-finger flap.

Providing soft-tissue coverage for a large defect in the single finger presents marked functional and aesthetic challenges. This article describes the reconstruction of such injuries using a modified ...

Early Versus Delayed Fourth Ray Amputation With Fifth Ray Transposition for Management of Mutilating Ring Finger Injuries.

To compare hand function after early versus delayed fourth ray amputation and transposition of the fifth ray in mutilating ring finger injuries.

Avascular Necrosis of the Metacarpal Head: A Case of Dietrich's Disease and Review of the Literature.

Background Isolated avascular necrosis of the metacarpal head, also known as Dietrich's disease, is a rare entity with few cases reported previously in the literature. It has been associated with ster...

Medical and Biotech [MESH] Definitions

A painful disability in the hand affecting the finger or thumb. It is caused by mechanical impingement of the digital flexor tendons as they pass through a narrowed retinacular pulley at the level of the metacarpal head. Thickening of the sheath and fibrocartilaginous metaplasia can occur, and nodules can form. (From Green's Operative Hand Surgery, 5th ed, p2137-58).

General or unspecified injuries involving the fingers.

The CARPAL BONES; METACARPAL BONES; and FINGER PHALANGES. In each hand there are eight carpal bones, five metacarpal bones, and 14 phalanges.

Interruption of sympathetic pathways, by local injection of an anesthetic agent, at any of four levels: peripheral nerve block, sympathetic ganglion block, extradural block, and subarachnoid block.

Disease involving the ULNAR NERVE from its origin in the BRACHIAL PLEXUS to its termination in the hand. Clinical manifestations may include PARESIS or PARALYSIS of wrist flexion, finger flexion, thumb adduction, finger abduction, and finger adduction. Sensation over the medial palm, fifth finger, and ulnar aspect of the ring finger may also be impaired. Common sites of injury include the AXILLA, cubital tunnel at the ELBOW, and Guyon's canal at the wrist. (From Joynt, Clinical Neurology, 1995, Ch51 pp43-5)

More From BioPortfolio on "Transthecal Metacarpal Block Versus Traditional Digital Block for Painful Finger Procedures in Children"


Advertisement
 

Relevant Topics

Anesthesiology
Latest News Clinical Trials Research Drugs Reports Corporate
An anesthesiologist (US English) or anaesthetist (British English) is a physician trained in anesthesia and perioperative medicine. Anesthesiologists are physicians who provide medical care to patients in a wide variety of (usually acute) situations. ...

Pediatrics
Latest News Clinical Trials Research Drugs Reports Corporate
Pediatrics is the general medicine of childhood. Because of the developmental processes (psychological and physical) of childhood, the involvement of parents, and the social management of conditions at home and at school, pediatrics is a specialty. With ...

Anesthesia
Latest News Clinical Trials Research Drugs Reports Corporate
Anesthesia is the loss of feeling or sensation in all or part of the body. It may result from damage to nerves or can be induced by an anesthetist (a medical professional) using anesthetics such as thiopental or propofol or sevoflurane during a surgical ...

Advertisement
 

Searches Linking to this Trial