Check the digit for blood supply, sensation, and motor nerve function before injecting the anesthetic agent The site of puncture on the digits for each is shown in Figure 130.48A , part A Consider procedural sedation, assistance from a child life specialist or employment of distraction techniques, and restraint if required Have an assistant grasp the extremity proximal to the digit to prevent movement The digital nerves, as shown in Figure 130.48A , part B, run laterally adjacent to the flexor and extensor tendons on both the dorsal and volar aspects of the digit, and lidocaine must be injected at both locations medially and laterally to block the four nerves (see closed circles, Fig 130.48A , part A) Cleanse the planned puncture sites on the medial and lateral aspect(s) of the digit thoroughly with antiseptic solution Use a 27- or 30-gauge needle attached to a 5-mL syringe and 1% lidocaine without epinephrine Inject the site at a 45degree angle from vertical advancing until the needle contacts the periosteum Withdraw the needle slowly to just under the skin surface and gently rotate the syringe to the vertical as shown in Figure 130.48A , part C Then, advance the needle to the volar surface while injecting anesthetic until at least three-fourths of the way through the digit Remove the needle completely, and then repeat the procedure on the other side of the digit in a similar manner Anesthesia should be achieved within to 10 minutes