Difference between revisions of "Hematoma block"

(External links added)
(ref)
(10 intermediate revisions by 5 users not shown)
Line 1: Line 1:
 
==Background==
 
==Background==
A hematoma block is a relatively noninvasive method of analgesia in preparation for relocation of a displaced fracture. The procedure involves the injection of a local anesthetic into a collection of blood that has extravasated into the soft tissue between two fragments of displaced bone. This extravasated blood exists because of damage to the blood vessels within the fractured bone. With injection of a local anesthetic into this "pool" of blood", painless manipulation of the involved fragments of bone is achieved, thus sparing the patient from more invasive analgesic techniques such as [[procedural sedation]] and the risks associated with that. One of the most common fractures that a hematoma block is used for is a [[Colles' fracture]], however displaced metacarpal and phalanx fractures are also common indications for a hematoma block.
+
*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
  
==Technique==
+
==Indications==
First, identify where the displaced fracture is. This is sometimes obvious when there is a gross deformity, however with more subtle deformities the area where the patient is most tender can help identify the precise location. Next, after the patient's skin has been properly cleaned, advance the needle while aspirating. Positive return of blood indicates correct needle tip placement, and at this point you can instill about 5-10 mL of lidocaine into the site, depending on the patient, where the fracture occurred, and how large the fracture is. Wait about several minutes while the anesthetizing agent takes affect, and proceed with alignment when the patient feels comfortable.
+
*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
  
 
==See Also==
 
==See Also==
[[Colles' Fracture]]<br />
+
*[[Colles' fracture]]
[[Procedural Sedation]]
+
*[[Procedural Sedation]]
  
 
==External Links==
 
==External Links==
 +
*https://www.youtube.com/watch?v=EhJ7kpurKnk
 +
*http://epmonthly.com/article/hematoma-blocks-for-reduction-of-distal-radius-fractures/
 +
 +
==References==
 +
<references/>
  
https://www.youtube.com/watch?v=EhJ7kpurKnk<br />
+
[[Category:Procedures]] [[Category:Orthopedics]]
http://epmonthly.com/article/hematoma-blocks-for-reduction-of-distal-radius-fractures/
 

Revision as of 15:02, 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) [1]
      • 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

  1. McGee D. Local and Topical Anesthesia. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.