The center of the palmer digital crease on the volar surface is identified as the injection site. 
- The hand is cleaned appropriately with betadine or chlorhexidine and a 25 gauge needle is inserted at the palmar digital crease penetrating through the flexor tendons to the bone.
- The needle is then withdrawn slowly while applying gentle pressure to the plunger of the syringe. Once the needle is in the tendon sheath space, the lidocaine flows easily.
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They recommend injecting 2-3 ml of lidocaine. It is also important to wait for the anesthetic to take full effect. I recommend waiting at least 7 to 10 minutes after the injection, then reassessing for satisfactory anesthesia.
