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©2013 UpToDate ® Print Email Local anesthetic block for trigger thumb The hand is placed flat on the table in the pulm up position with the thumb abducted. A topical anesthetic, such as ethyl chloride, is applied to the skin. A short (eg, 5/8 inch, or 1.5 cm) 25 gauge needle is inserted perpendicular to the skin directly over the center of the tendon, between the flexor creases, to a depth of approximately 1/8 to 1/4 inch (0.3 to 0.6 cm), just to the level of the tendon, and 0.25 mL lidocaine is injected. Courtesy of Bruce C Anderson, MD.