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- The needle is then withdrawn slowly while applying gentle pressure to the plunger of the syringe.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.
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.