SIMPLE block

Ring blocks are easy but they hurt. Anyone who has had one can testify to this. This, literally simple, technique can be used with a 30g or 27g needle to make it even kinder for the patient.

Remember to go slow with the injection and it's only 2mls front +/- back so doesn't take long, lasts ages and patients find it preferable to a traditional ring block.

If you're operating distal to the proximal interphalangeal joint (PIPJ), sing Walant then a palmar injection will suffice. If using a digital tourniquet or operating on or proximal to the PIPJ then a dorsal one is required as well.

Also remember that there is not a single case of necrotic finger attributable to xylocaine with 1:100 000 or 1:200 000 adrenaline in the literature. This is an historic myth when LA was allowed to get down to pH 1!