Determine approach
Withdraw needle and repeat on the other side
Test for adequate analgesia and if lacking, inject more anesthetic or consider other analgesic procedure
Contraindications to midazolam
Obtain 25 - 30 gauge needle with 1% lidocaine (buffered and warmed) and consider epinephrine if extensive bleeding expected
Determine approach
Contraindications to midazolam?
Sterilize the puncture site with providone-iodine or chlorhexidine
Contraindications to nitrous oxide?
Patient to require anxiolysis?
Contraindications to nitrous oxide
Wing block
Intranasal or Oral midazolam 20 min prior to procedure
Transthecal block
Toe digital block
Three-sided great toe block
Partially withdraw needle and redirect over the dorsum of the toe and inject anesthetic
Web space block