Hematoma Block For Distal Radius Fractures Dr Melia

Hematoma Block For Distal Radius Fractures Dr Melia Condon 2019

Hematoma Block What is it? BACKGROUND q Method of providing local anaesthesia/analgesia around the site of a fracture q Involves the injection of local anaesthetic into the hematoma that forms between the two fragments of fractured bone q Typically used for Colle’s fractures, occasionally ankle fractures q Provides an alternative to procedural sedation

Pros and Cons Pros Less resource and personnel intensive Shorter Stay in ED Avoid side effects of sedating drugs Does not require IV access or cardiac monitoring q Can use both a short and long acting local anaesthetic for both rapid onset and longer acting analgesia q q Cons VS q Discomfort associated with injection into the fracture site initially q If several hours after injury then the hematoma may already have begun to organise and be unaspiratable

Hematoma Block What? Why Not? Indications q Closed extremity fractures in adults or children that require closed reduction q Can also be used for intraarticular fracture/dislocations q Limited resources means procedural sedation is impractical or impossible q Analgesia alone when manipulation is not required Contraindications q q q Open fracture Overlying cellulitis Allergy to local anaesthetic Neurovascular deficit of the distal limb Uncooperative patient q Relative q Bleeding disorders/anticoagulants q Potential for compartment syndrome if further bleeding into an enclosed space results Equipment Sterile gloves and gown Face mask Chlorhexadine/iodine solution Sterile drapes Local anaesthetic WITHOUT adrenaline q Usually 1% Lignocaine q Syringes (10+ml) q 22 -23 gauge needle (spinal for obese patients) q q q Optional: q USS

Procedure How do I do it? Step-by-step Explain the procedure and obtain consent. The procedure is the same for both adults and children. The patient may require supplemental analgesia to facilitate the block. Identify Injection Site Dorsal aspect of wrist (less structures to avoid) Skin Prep Aseptic technique is required. Apply chlorhexadine, or iodine solution and allow to dry. Apply sterile drapes. Needle insertion Enter skin directly over the fracture; either blind through the loss of resistance or with USS Confirmation of location Draw back on syringe positive if aspirating haematoma Injection of Local Anaesthetic Inject 0. 3 ml/kg up to 10 ml of 1% lignocaine. Can inject in single location or reposition to distribute more evenly Closed Reduction Await 5 -10 mins post injection before attempting reduction

Complications What could go wrong…? Compartment Syndrome Local Anaesthetic Toxicity Higher risk with bleeding disorder or on anticoagulants Early signs: circumoral/tongue numbness/paresthesia, dizziness, mental status decline, tinnitus & visual disturbances CVS effects: Asystole, dysrhythmias, ↓BP Neuro effects: Agitation, coma, confusion, headaches, seizures and possibly death Osteomyelitis Injury to Neurovascular structures From the introduction of bacteria into the previous sterile space between the fracture fragments. Minimized by aseptic technique Damage to arteries, veins or nerve, although minimized by dorsal approach

Useful links Need more info? Simple Summary of procedure: https: //wikem. org/wiki/Hematoma_b lock Video of procedure: https: //www. youtube. com/watch? v= 6_JUf 8 voel. Q 1 3 Lower Limb Haematoma block 2 Video of ultrasound guided procedure: 4 Another simple summary page: http: //epmonthly. com/article/hematomablocks-for-reduction-of-distal-radiusfractures/ 5 https: //litfl. com/use-hematomablocks-for-wilderness-anesthesia/ 6 https: //vimeo. com/125858537 Local Anaesthetic Toxicity Management: https: //www. aagbi. org/sites/default/ files/la_toxicity_2010_0. pdf