View source for Hematoma block

==Background==
*Method of providing local anesthesia/analgesia around the site of a fracture as an alternative to procedural sedation when reduction or manipulation is required
*Involves injecting anesthetic into the hematoma that forms around fracture site
*Commonly used for [[Colles' fracture]] and [[ankle fracture]]s

==Indications==
*Need for closed reduction or manipulation of any diaphyseal or metaphyseal fracture

==Contraindications==
*Open fracture

==Equipment==
*Sterile gloves
*Sterile gauze
*Antiseptic (e.g. chlorhexidine or alcohol)
*Syringe
*Needles (large bore for drawing up local, small gauge for injection)
*Anesthetic (e.g. 2% [[lidocaine]] or 0.5% bupivicaine)

==Procedure==
*Position extremity on hard surface
*Find landmarks
**Fracture site based on imaging
**Area of swelling or deformity
*Draw up anesthetic
*Prep skin
*Enter skin directly over fracture
**Advance needle until bone encountered 
**Aspirate until blood is seen to confirm placement within hematoma
**Inject anesthetic (5 to 15 mL of plain 1% lidocaine or 5 to 10 mL of plain 2% lidocaine) <ref name="Local and Topical Anesthesia">McGee D. Local and Topical Anesthesia. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014. </ref>
***Goal is to anesthetize bone and periosteum
*Remove needle, apply pressure with gauze
*Dress site, proceed with reduction(s) only after 5-10 minutes when block is fully in effect

==Pearls==
*Can use a combination of lidocaine and bupivicaine for rapid onset and longer acting analgesia/anesthesia
*Can use C-arm to guide the needle to the fracture site to increase the chance of successful block in distal radius fractures  
*If it has been several hours since injury, hematoma may have already started to organize and be unaspiratable
*[[Ultrasound]]-guidance may improve success<ref>Gottlieb M, Cosby K. Ultrasound-guided hematoma block for distal radial and ulnar fractures. J Emerg Med. 2015;48(3):310-312. doi:10.1016/j.jemermed.2014.09.063</ref>

==See Also==
*[[Colles' fracture]]
*[[Procedural Sedation]]

==External Links==
*https://www.youtube.com/watch?v=EhJ7kpurKnk
*http://epmonthly.com/article/hematoma-blocks-for-reduction-of-distal-radius-fractures/

==References==
<references/>

[[Category:Procedures]] [[Category:Orthopedics]]