title: Decreasing the pain of finger block injection: level II evidence.
abstract: BACKGROUND
  There is level II evidence that volunteers prefer the single subcutaneous injection in the midline of the proximal phalanx with lidocaine and epinephrine (SIMPLE) finger block over the classic two dorsal injection block technique. The purpose of this study was to possibly further decrease the pain of digital block injection by examining the effect of the duration of injection on the pain felt by volunteers receiving the SIMPLE block at two different injection rates.
  
  
  METHODS
  Forty healthy blinded volunteers were injected 2 mL of lidocaine 1 % and epinephrine 1/100,000 in the digital palmar crease of both long fingers, one at a time. Two different rates of injection were used: 8 and 60 s. Pain scores were measured using a visual analogue scale and the volunteers were asked which of injection techniques they preferred.
  
  
  RESULTS
  The visual analogue scale results revealed less pain with the slow injection (p < 0.001). Thirty three out of 40 volunteers preferred the slow injection rate. No difference could be attributed to sex of participants or to the first hand injected.
  
  
  CONCLUSIONS
  Blinded volunteers preferred digital blocks injected over 60 s to the more rapid 8 s. Decreasing the pain of injection only takes a minute of our valuable time for finger blocks.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, 1560 Sherbrooke East, Montréal, Québec Canada H2L 4M1.
authors.forename: Nicolas D
authors.initials: ND
authors.lastname: Hamelin
authors.affiliation: Division of Plastic and Reconstructive Surgery, Hopital de Gatineau, 909 La Vérendrye boulevard, Gatineau, Québec Canada J8P 7H2.
authors.forename: Hugo
authors.initials: H
authors.lastname: St-Amand
authors.affiliation: Division of Plastic Surgery, Dalhousie University, Hilyard Place, Suite C204, 600 Main Street, Saint John, New Brunswick Canada E2K 1J5.
authors.forename: Donald H
authors.initials: DH
authors.lastname: Lalonde
authors.affiliation: Division of Plastic and Reconstructive Surgery, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, 1560 Sherbrooke East, Montréal, Québec Canada H2L 4M1.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Harris
authors.affiliation: Institut de Chirurgie Spécialisée de Montréal, 6100 avenue du Boisé, suite 112, Montréal, Québec Canada H3S 2W1.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Brutus
keywords: Digital block; Epinephrine; Injection rate; Lidocaine; Pain