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Hematoma Block

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Other Names

  • Hematoma Block

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

Indications


Contraindications

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

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)[1]
  • Goal is to anesthetize bone and periosteum
  • Remove needle, apply pressure with gauze
  • Apply post procedure bandage, repeat neurovascular exam

Ultrasound Guided Technique

Ultrasound guided hematoma block
  • Prior to procedure, evaluate fracture sonographically
    • Evaluate the fracture in long and short axis
    • Ultrasound may improve success[2]
  • 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

Aftercare

  • Apply bandage
  • Prepare for reduction
  • Monitor for complications

Complications


See Also


References

  1. McGee D. Local and Topical Anesthesia. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.
  2. Gottlieb M, Cosby K. Ultrasound-guided hematoma block for distal radial and ulnar fractures. J Emerg Med. 2015;48(3):310-312. doi:10.1016/j.jemermed.2014.09.063
Created by:
John Kiel on 11 November 2022 07:17:43
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Last edited:
11 November 2022 09:17:13
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