Hematoma block
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