What are the steps for performing a hematoma block?

Hematoma Block Procedure Steps

A hematoma block should be performed using a systematic approach that includes proper preparation, sterile technique, and careful administration of local anesthetic directly into the fracture hematoma to provide effective anesthesia for fracture reduction.

Preparation

• Obtain informed consent from the patient
• Gather necessary equipment:
  • Antiseptic solution (chlorhexidine or povidone-iodine)
  • Sterile gloves
  • 10-20 mL of local anesthetic (typically 1-2% lidocaine without epinephrine)
  • 18-20 gauge needle for aspiration and injection
  • Sterile gauze and dressings
  • Emergency equipment in case of complications

Step-by-Step Procedure

1. Patient positioning

   • Position the patient comfortably with the fracture site exposed
   • Ensure adequate lighting and access to the fracture site

2. Site identification

   • Identify the fracture site using clinical examination and radiographic guidance
   • Mark the entry point (typically where the hematoma is most prominent)

3. Skin preparation

   • Clean the area with antiseptic solution using sterile technique
   • Allow the antiseptic to dry completely

4. Anesthetic preparation

   • Draw up 10-20 mL of local anesthetic (1-2% lidocaine without epinephrine) 1, 2
   • Avoid using epinephrine as it may cause vasoconstriction and tissue ischemia

5. Needle insertion and aspiration

   • Insert the needle perpendicular to the skin at the marked entry point
   • Advance the needle until it reaches the fracture hematoma
   • Aspirate to confirm placement within the hematoma (blood return confirms correct placement)

6. Anesthetic injection

   • Slowly inject the local anesthetic into the fracture hematoma
   • Distribute the anesthetic throughout the fracture site by redirecting the needle if necessary
   • Withdraw the needle after injection

7. Wait for anesthetic effect

   • Allow 10-15 minutes for the anesthetic to take effect
   • Assess pain level using a visual analog scale before attempting reduction 1

8. Fracture reduction

   • Proceed with fracture reduction once adequate anesthesia is achieved
   • Apply appropriate immobilization after reduction

Monitoring and Complications Management

• Monitor vital signs throughout the procedure
• Watch for signs of systemic toxicity from local anesthetic (perioral numbness, tinnitus, seizures) 3
• Be prepared to manage potential complications:
  • Local anesthetic toxicity
  • Infection
  • Hematoma formation
  • Inadequate pain control

Advantages and Considerations

• Hematoma blocks provide effective anesthesia comparable to other methods 1, 4
• They require fewer resources and less time compared to procedural sedation 2
• This technique is particularly useful for closed, isolated fractures requiring manipulation 4
• Consider alternative anesthesia methods if the hematoma block is contraindicated or ineffective

Documentation

• Document the procedure including:
  • Type and amount of anesthetic used
  • Patient's response to the procedure
  • Any complications encountered
  • Post-procedure instructions

The hematoma block is a safe and effective alternative to intravenous sedation for fracture reduction when performed with proper technique and in appropriate clinical scenarios 1, 4, 2.