Hematoma blocks are a simple, quick, and effective mode of regional anesthesia for isolated closed fracture reduction. Although hematoma blocks are safe the anesthesia that they provide is not as efficacious as the intravenous regional Bier block (see below). The hematoma block is a useful alternative when the Bier block is contraindicated.28
Technique Superficial anesthesia is obtained with local infiltration or other technique such as EMLA applied to the skin over the fracture site. An analgesic dose of narcotic can also be given if deemed appropriate. The fracture site is identified and using sterile technique, the hematoma is aspirated using a 10-mL syringe and 20-to 22-gauge needle. Lidocaine 1% without epinephrine is infiltrated (3 to 10 mL, maximum of 0.5 mL/kg) into the fracture cavity and around the periosteum. The block is effective within 5 to 10 min, with several hours duration.
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