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 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)
    • 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

See Also

• Colles' fracture
• Procedural Sedation

External Links

• https://www.youtube.com/watch?v=EhJ7kpurKnk
• http://epmonthly.com/article/hematoma-blocks-for-reduction-of-distal-radius-fractures/