Injections into soles, palms, and digits are:
.difficult - septate areas with injection being forced and sometimes
ineffective if only some of the compartments are infiltrated.
.ineffective for deeper tissue
Nerve blocks always work provided your knowledge of anatomy is good and you
are prepared to WAIT. I often catch residents assuming that blocks have not
worked because sensation is present after a few minutes only.
For lacs or F.B.s on soles a posterior tibial nerve block provides excellent
analgesia for skin and deeper tissues - particularly relevant for fishing
out a F.B. - and topical L.A. can be used at the injection site for children.
Steri-strips are useful for superficial lacs only as they leave a 'dead
space' with deeper wounds inviting infection.
I've never met a child able to keep their feet clean for one day let alone
long enough for a wound to heal properly. My preference is to suture gapping
wounds on soles of feet and I use nerve blocks preferentially for both
paediatric and adult patients.
Dr Garry Wilkes MBBS FACEM
Department of Emergency Medicine
Royal Brisbane Hospital
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