Hematoma block

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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.