Hematoma Block

Other Names

• Hematoma Block

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Background

• Hematoma blocks is a method of providing anesthesia and analgesia around a fracture site
  • This may act as an alternative to other forms of analgesia (medications, nerve block, sedation)
  • It may act as an adjunct to other forms of analgesia
• Characterized by injecting anesthetic into the hematoma around the fracture

Anatomy

• Can be applied to any long bone fracture with a cortical break

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Indications

• Need for reduction of one of the following:
  • Distal Radius Fractures
  • Ankle Fractures
• In theory, can be used for any fracture

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Contraindications

• Relative
  • Requires emergent surgical intervention
  • Open fracture
  • Pain can be controlled with less invasive means
• Absolute
  • Allergy to local anesthetic

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Procedure

Demonstration of a hematoma block for a distal radius 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% bupivacaine)

Preparation

• Place affected extremity in relative position of comfort
  • Limb should be positioned on a hard surface
• Patient should be seated or resting in a position of comfort

Palpation Guided Technique

• Find landmark(s)
  • Fracture site based on imaging
  • Area of swelling or deformity
• Draw up anesthetic
• Prep skin
• Enter skin directly over fracture
  • Recommend marking skin for point of entry prior to sterilizing
• Advance needle until bone encountered
  • Aspirate until blood is seen to confirm placement within hematoma
  • Note, longer the time since fracture the less likely you will be able to aspirate clotted blood
  • 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
• Apply post procedure bandage, repeat neurovascular exam

Ultrasound Guided Technique

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Ultrasound guided hematoma block

• Prior to procedure, evaluate fracture sonographically
  • Evaluate the fracture in long and short axis
  • Ultrasound may improve success
• Identify optimal point of entry
• Mark skin
• Sterilize skin, apply probe cover, etc
• We recommend in-plane technique if possible
  • Needle visualization should not be difficult with a linear probe
• Advance needle towards mark under US guidance
  • Aspirate for blood return
  • Inject at cortical break
• Apply post procedural bandage, repeat neurovascular exam

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Aftercare

• Apply bandage
• Prepare for reduction
• Monitor for complications

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Complications

• Local Anesthetic Systemic Toxicity
• Need for more analgesia
• Intra-vascular injection

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See Also

• Procedures Main
• Fracture Management

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