Start the injection at the proximal aspect of the incision site. Inject 1ml first and wait 10-20 seconds before continuing with the injection. This will give time for the LA to start numbing the skin so further injections will be painless. Do note that I am using a 30-gauge needle to inject the local anesthesia subcutaneously. Do not inject the needle beyond the swollen skin area. Keep injecting the local anesthesia until it reaches the end of the incision site distantly. You can see clearly here that my needle never go beyond the tumus area. The small needle helps to slow the injection time as we need more pressure to push the local anesthesia in. Go as slow as possible as this will reduce the injection pain. A total of 10ml of one-arm solution will be given at the incision site. For the periosteal injection, divide it into 3 areas and start by giving it proximally to distally. Using a 25-gauge needle, about 10ml of one-arm solution will be given here. At each site, start by giving 2ml of one-arm solution at the lateral aspect of the distal radius. Then walk the bone volarly and inject further 4ml of one-arm solution. This is important to prevent injury to the radial artery and nerve. Next, walk the bone dorsally and give further 4ml of one-arm solution here. This will circumferentially numb the distal radius. Repeat the same periosteal injection technique at the radial silent region. Remember to walk the bone to prevent injury to the neurovascular structures here. The injection is complete once the patient is not in pain while manipulating the fracture site.

local anesthesia

subcutaneous injection

periosteal injection

fracture manipulation

pain relief