FIGURE 130.47 Field block for local anesthesia An alternative approach to the digital nerve block is to block the nerve at the level of the metacarpophalangeal joint or just proximal to it This method may be less painful and may have fewer complications than a more distal block The block is performed by inserting a 25-gauge, 5/8-in needle along each side of the metacarpal at the interdigital fold in line with the web space Insert the needle into the web space until the tip is at the level of the metacarpophalangeal joint (1 to cm) and inject to mL of 1% lidocaine ( Fig 130.48A , part D) For the index finger, place a half-ring wheal of lidocaine along the radial side of the proximal aspect of the finger For the fifth digit, inject a similar wheal along the ulnar border to anesthetize the lateral aspect For the thumb, a half-ring wheal of lidocaine can be placed along the radial aspect of the metacarpophalangeal joint The web space between the thumb and index finger is approached as outlined above Proximal digital nerve block Figure 130.48A , part A shows the location of the more proximal block (see the open circles) Inject these areas when the entire finger, including the proximal phalanx, must be anesthetized The nerve is closer to the palmar surface here, making it best to inject the anesthetic closer to the palmar surface Supraorbital Nerve Block Indications Lacerations within sensory distribution of the nerve ( Fig 130.48B ) Removal of a foreign body