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
  
 
==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==
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*Inject anesthetic
 
*Inject anesthetic
 
**enter skin directly over fracture
 
**enter skin directly over fracture
**aspirate as advancing
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**advance towards fracture while aspirating
**aspiration of very dark blood--> you're in the hematoma
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**Once hematoma is aspirator, stop and inject anesthetic
**inject the rest of the anesthetic
 
 
*Remove needle, apply pressure with gauze
 
*Remove needle, apply pressure with gauze
 
*Dress site
 
*Dress site
  
 
==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
 
*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]]
https://www.youtube.com/watch?v=EhJ7kpurKnk<br />
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*[[http://epmonthly.com/article/hematoma-blocks-for-reduction-of-distal-radius-fractures/]]
http://epmonthly.com/article/hematoma-blocks-for-reduction-of-distal-radius-fractures/
 
  
 
==References==
 
==References==
 +
</references>

Revision as of 01:18, 2 September 2016

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

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
  • Inject anesthetic
    • enter skin directly over fracture
    • advance towards fracture while aspirating
    • Once hematoma is aspirator, stop and inject anesthetic
  • Remove needle, apply pressure with gauze
  • Dress site

Pearls

  • Can use a combination of lidocaine and bupivicaine for rapid onset 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

External Links

References

</references>