Hematoma block: Difference between revisions
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==Background== | ==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 fracture]]s | |||
==Indications== | ==Indications== | ||
* | *Need for closed reduction or manipulation of any diaphyseal or metaphyseal fracture | ||
==Contraindications== | ==Contraindications== | ||
* | *Open fracture | ||
==Equipment== | ==Equipment== | ||
*Sterile gloves | *Sterile gloves | ||
*Sterile | *Sterile gauze | ||
*Antiseptic (e.g. chlorhexidine or alcohol) | *Antiseptic (e.g. chlorhexidine or alcohol) | ||
* | *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]] | *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 | ||
** | **Area of swelling or deformity | ||
*Draw up anesthetic | *Draw up anesthetic | ||
*Prep skin | *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 | *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== | ||
* | *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 | *If it has been several hours since injury, hematoma may have already started to organize and be unaspiratable | ||
*[[Ultrasound]]-guidance may improve success<ref>Gottlieb M, Cosby K. Ultrasound-guided hematoma block for distal radial and ulnar fractures. J Emerg Med. 2015;48(3):310-312. doi:10.1016/j.jemermed.2014.09.063</ref> | |||
==See Also== | ==See Also== | ||
[[Colles' | *[[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/> | |||
[[Category:Procedures]] [[Category:Orthopedics]] |
Latest revision as of 22:50, 11 February 2021
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
- Ultrasound-guidance may improve success[2]
See Also
External Links
- https://www.youtube.com/watch?v=EhJ7kpurKnk
- http://epmonthly.com/article/hematoma-blocks-for-reduction-of-distal-radius-fractures/
References
- ↑ McGee D. Local and Topical Anesthesia. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.
- ↑ Gottlieb M, Cosby K. Ultrasound-guided hematoma block for distal radial and ulnar fractures. J Emerg Med. 2015;48(3):310-312. doi:10.1016/j.jemermed.2014.09.063