Difference between revisions of "Hematoma block"

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==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.
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*Method of providing local anesthesia/analgesia around the site of a fracture as an alternative to procedural sedation when reduction or manipulation is required
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*Involves injecting anesthetic into the hematoma that forms around fracture site
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*Commonly used for [[Colles' fracture]] and ankle fractures
  
 
==Indications==
 
==Indications==
*Closed reduction of any diaphyseal or metaphyseal fracture
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*Need for closed reduction or manipulation of any diaphyseal or metaphyseal fracture
**Most commonly used for distal radial fracture reduction
 
  
 
==Contraindications==
 
==Contraindications==
*Broken or tenous skin overlying fracture
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*Open fracture
*Not effective in open fractures
 
  
 
==Equipment==
 
==Equipment==
 
*Sterile gloves
 
*Sterile gloves
*Sterile guaze
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*Sterile gauze
 
*Antiseptic (e.g. chlorhexidine or alcohol)
 
*Antiseptic (e.g. chlorhexidine or alcohol)
*Synringe
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*Syringe
 
*Needles (large bore for drawing up local, small gauge for injection)
 
*Needles (large bore for drawing up local, small gauge for injection)
*Anesthetic (e.g. 2% [[lidocaine]] and/or 0.5% bupivicaine)
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*Anesthetic (e.g. 2% [[lidocaine]] or 0.5% bupivicaine)
  
 
==Procedure==
 
==Procedure==
 
*Position extremity on hard surface
 
*Position extremity on hard surface
 
*Find landmarks
 
*Find landmarks
**fracture site based on imaging
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**Fracture site based on imaging
**area of swelling or deformity
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**Area of swelling or deformity
 
*Draw up anesthetic
 
*Draw up anesthetic
 
*Prep skin
 
*Prep skin
*Inject anesthetic
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*Enter skin directly over fracture
**enter skin directly over fracture
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**Advance needle until bone encountered
**aspirate as advancing
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**Aspirate until blood is seen to confirm placement within hematoma
**aspiration of very dark blood--> you're in the hematoma
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**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>
**inject the rest of the anesthetic
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***Goal is to anesthetize bone and periosteum
 
*Remove needle, apply pressure with gauze
 
*Remove needle, apply pressure with gauze
*Dress site
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*Dress site, proceed with reduction(s) only after 5-10 minutes when block is fully in effect
  
 
==Pearls==
 
==Pearls==
*Use a combination of lidocaine and bupivicaine for both immediate and longer acting analgesia/anesthesia
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*Can use a combination of lidocaine and bupivicaine for rapid onset and longer acting analgesia/anesthesia
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*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
 
*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 />
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*[[Colles' fracture]]
[[Procedural Sedation]]
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*[[Procedural Sedation]]
  
 
==External Links==
 
==External Links==
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*https://www.youtube.com/watch?v=EhJ7kpurKnk
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*http://epmonthly.com/article/hematoma-blocks-for-reduction-of-distal-radius-fractures/
  
https://www.youtube.com/watch?v=EhJ7kpurKnk<br />
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==References==
http://epmonthly.com/article/hematoma-blocks-for-reduction-of-distal-radius-fractures/
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<references/>
  
==References==
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[[Category:Procedures]] [[Category:Orthopedics]]

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.