Digital Block of the Thumb: Technique and Dosage

Recommended Dosage

The American Academy of Pediatrics recommends a maximum safe dose of 4.5 mg/kg body weight, not exceeding 300 mg total, for lidocaine without epinephrine 1
The maximum safe dose with epinephrine is 7.0 mg/kg body weight, not exceeding 500 mg total, as recommended by the American Academy of Pediatrics 1
For children, the American Academy of Pediatrics recommends reducing amide local anesthetic doses by 30% in infants younger than 6 months 1
The maximum dose for children is 4.4 mg/kg without epinephrine, as recommended by the American Academy of Pediatrics 1

The American Society of Anesthesiologists recommends calculating the total dose of all local anesthetics administered from any route to avoid exceeding maximum safe doses 2
The American Society of Anesthesiologists advises against performing digital blocks within 4 hours of any other local anesthetic intervention 4
The American Academy of Pediatrics recommends having suction equipment, adequate oxygen supply, and properly stocked rescue cart with age-appropriate resuscitation equipment available 1
The American Society of Regional Anesthesia and Pain Medicine recommends keeping 20% lipid emulsion readily available for treatment of local anesthetic systemic toxicity 1, 4

The American Academy of Pediatrics reports that the duration of anesthesia with lidocaine is 90-200 minutes (1.5-3.3 hours) 1

The American Academy of Pediatrics recommends avoiding injecting into highly vascular areas where lower doses should be used due to increased systemic absorption 1