Hematoma block: Difference between revisions

(→‎Procedure: clarification)
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*Position extremity on hard surface
*Position extremity on hard surface
*Find landmarks
*Find landmarks
**fracture site based on imaging
**Fracture site based on imaging
**area of swelling or deformity
**Area of swelling or deformity
*Draw up anesthetic
*Draw up anesthetic
*Prep skin
*Prep skin
*Inject anesthetic
*Enter skin directly over fracture
**enter skin directly over fracture
**Advance needle until bone encountered
**advance towards fracture while aspirating
**Aspirate until blood is seen to confirm placement within hematoma
**Once hematoma is aspirator, stop and inject anesthetic
**Inject anesthetic (5 to 15 mL of plain 1% lidocaine or 5 to 10 mL of plain 2% lidocaine)
***Goal is to anesthetize bone and periosteum
*Remove needle, apply pressure with gauze
*Remove needle, apply pressure with gauze
*Dress site
*Dress site, proceed with reduction(s) only after 5-10 minutes when block is fully in effect


==Pearls==
==Pearls==

Revision as of 15:01, 14 April 2017

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 fractures

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)
      • 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

See Also

External Links

References