Chapter 2 Hematoma Block

Overview

1. A hematoma block may be performed anywhere an acute fracture is present.

2. Typically, hematoma blocks are performed in regions where selective nerve blocks or regional blocks are impractical to perform.

3. Hematoma blocks function on the principle that a fracture hematoma surrounds a fracture site.

a. The fracture hematoma acts as a fluid medium; thus injection of anesthetic into the hematoma results in diffusion of the anesthetic around the fracture site.

b. Diffusion of the anesthetic around the fracture site results in effective regional anesthesia.

Indications for use

1. Hematoma blocks are most commonly used for closed reduction of a distal radius fracture.

2. Any diaphyseal or metaphyseal fracture is amenable to a hematoma block.

Precautions

1. Hematoma blocks should not be used in patients with broken or tenuous skin overlying the fracture site.

2. Hematoma blocks typically are ineffective in open fractures.

Pearls

1. A combination of lidocaine and bupivacaine is used to provide both immediate and lasting analgesia. Use of bupivacaine is not mandatory, but fracture reductions are painful, and the use of a long-acting analgesic facilitates recovery in the postreduction period.

2. The injection site can be reasonably approximated with use of palpation and radiographs. Because the periosteum is extremely sensitive, the practice of “walking” the needle down the bone until the fracture site is reached should be avoided.

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