POTD: HEMATOMA BLOCK

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OVERVIEW

  • The hematoma block is local anesthesia delivered to the hematoma formation around a fracture site and done prior to reduction

  • Simple, fast, and does not require special equipment

  • Can be used for a variety of fractures (Colles’, ankle) and reductions

  • Has fallen out of favor due to rising popularity of procedural sedation

  • Does not increase the risk of infection

PROCEDURE

  1. Draw up 5 to 20 mLs of local anesthetic

  2. Find landmarks

  3. Clean area with chloraprep

  4. Insert the needle directly into the hematoma, withdrawing as you go

  5. Alternatively, use POCUS to identify the dark, anechoic hematoma

  6. Blood aspiration helps to confirm needle position

  7. Inject anesthetic, remembering not to exceed max dose

  8. Proceed with reduction after 5-10 min

CONTRAINDICATIONS

  • DO NOT perform procedure through a contaminated wound

  • DO NOT perform procedure on open fractures

TIPS and TRICKS

  • Use a combination of lidocaine and bupivicaine for rapid onset and longer acting anesthesia/analgesia

  • Note that after a few hours, hematomas can become unaspiratable

Sources:

  1. Tintinalli's Emergency Medicine, 9th Edition pp 247-248

  2. WikiEM: Hematoma Block

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