Difference between revisions of "Hematoma block"

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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.
 
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.
  
==Technique==
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==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.
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*Closed reduction of any diaphyseal or metaphyseal fracture
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**Most commonly used for distal radial fracture reduction
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==Contraindications==
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*Broken or tenous skin overlying fracture
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*Not effective in open fractures
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==Equipment==
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*Sterile gloves
 +
*Sterile guaze
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*Antiseptic (e.g. chlorhexidine or alcohol)
 +
*Synringe
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*Needles (large bore for drawing up local, small gauge for injection)
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*Anesthetic (e.g. 2% [[lidocaine]] and/or 0.5% bupivicaine)
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==Procedure==
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*Position extremity on hard surface
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*Find landmarks
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**fracture site based on imaging
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**area of swelling or deformity
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*Draw up anesthetic
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*Prep skin
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*Inject anesthetic
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**enter skin directly over fracture
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**aspirate as advancing
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**aspiration of very dark blood--> you're in the hematoma
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**inject the rest of the anesthetic
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*Remove needle, apply pressure with gauze
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*Dress site
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==Pearls==
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*Use a combination of lidocaine and bupivicaine for both immediate and longer acting analgesia/anesthesia
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*If it has been several hours since injury, hematoma may have already started to organize and be unaspiratable
  
 
==See Also==
 
==See Also==
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https://www.youtube.com/watch?v=EhJ7kpurKnk<br />
 
https://www.youtube.com/watch?v=EhJ7kpurKnk<br />
 
http://epmonthly.com/article/hematoma-blocks-for-reduction-of-distal-radius-fractures/
 
http://epmonthly.com/article/hematoma-blocks-for-reduction-of-distal-radius-fractures/
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 +
==References==

Revision as of 15:18, 30 August 2016

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.

Indications

  • Closed reduction of any diaphyseal or metaphyseal fracture
    • Most commonly used for distal radial fracture reduction

Contraindications

  • Broken or tenous skin overlying fracture
  • Not effective in open fractures

Equipment

  • Sterile gloves
  • Sterile guaze
  • Antiseptic (e.g. chlorhexidine or alcohol)
  • Synringe
  • Needles (large bore for drawing up local, small gauge for injection)
  • Anesthetic (e.g. 2% lidocaine and/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
  • Inject anesthetic
    • enter skin directly over fracture
    • aspirate as advancing
    • aspiration of very dark blood--> you're in the hematoma
    • inject the rest of the anesthetic
  • Remove needle, apply pressure with gauze
  • Dress site

Pearls

  • Use a combination of lidocaine and bupivicaine for both immediate and longer acting analgesia/anesthesia
  • If it has been several hours since injury, hematoma may have already started to organize and be unaspiratable

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