Among the commonest of the so-called bread and butter surgical procedures are minor operations on the fingers and toes under regional anesthesia produced by blocking the digital nerves at the base of the digit. As commonly employed the technic involves the injection of a 0.5 to 2 per cent solution of freshly prepared procaine hydrochloride (with or without a small amount of epinephrine added) into the base of the proximal phalanx either by circular infiltration or by deposition of the anesthetic in the region of the lateral digital nerves. It has been generally recommended that a tourniquet be applied at the base of the digit in order to delay absorption of the procaine into the general circulation, thus enhancing its local effect.
Garlock, in pointing out that this widely followed procedure is not entirely without danger and that gangrene of the involved digit may supervene, attributed this complication to the
KAUFMAN PA. GANGRENE FOLLOWING DIGITAL NERVE BLOCK ANESTHESIAREPORT OF A CASE. Arch Surg. 1941;42(5):929-938. doi:10.1001/archsurg.1941.01210110131011