Hematoma block

Revision as of 23:12, 10 September 2016 by ClaireLewis (talk | contribs)

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