Hematoma Block Research Articles

Haematoma block: Assessment of postoperative analgesic effect following manipulation of distal forearm fractures

Abstract Haematoma block has been shown to provide a safe and effective method of analgesia for the manipulation of wrist fractures in adults, 1 but has previously been little used in paediatric anaesthetic practice. There is little published data on the use of this technique for postoperative analgesia. The aim of this study was to assess the efficacy of haematoma block in providing postoperative analgesia in children following manipulation of distal forearm fractures. Forty healthy children with fractures of the distal radius and ulna were randomised to one of two groups. Against the background of a standard general anaesthetic, the patients were randomly allocated to receive either 1 ml of normal saline per 10 kg body weight or 1 ml of 0.25% bupivacaine per 10 kg of body weight injected into the fracture site under general anaesthesia prior to manipulation of the fracture. Clinical staff were unaware as to the nature of the injected solution. The two groups were compared in terms of postoperative analgesic requirements, the time to first analgesia, and in terms of half hourly pain and sedation scores. The children in the bupivacaine group had significantly lower pain scores throughout the whole study period. The median pain scores for the bupivacaine group were significantly better at 30, 60 and 90 minutes. The median time to first analgesia was 120 minutes for the bupivacaine group and 90 minutes for the saline group. This study shows that intraoperative haematoma block with 0.25% bupivacaine improves pain scores in the early postoperative period and prolongs the time to first analgesia.

Anesthesia and analgesia for the ambulatory management of fractures in children.

The goal of anesthesia in the ambulatory management of fractures in children is to provide analgesia and relieve anxiety in order to facilitate successful closed treatment of the skeletal injury. Numerous techniques short of general anesthesia are available. These methods include blocks (local, regional, and intravenous), sedation (conscious and deep), and dissociative anesthesia (ketamine sedation). Important factors in choosing a particular technique include ease of administration, efficacy, safety, cost, and patient and parent acceptance. Local and regional techniques, such as hematoma, axillary, and intravenous regional blocks, are particularly effective for upper-extremity fractures. Sedation with inhalation agents, such as nitrous oxide, and parenterally administered narcotic-benzodiazepine combinations, are not region-specific and are suitable for patients over a wide range of ages. Ketamine sedation is an excellent choice for children less than 10 years old. With any technique, proper monitoring and adherence to safety guidelines are essential.

Haematoma block: a potentially useful technique for Australasia

AbstractHaematoma block is a simple, safe and effective anaesthetic technique used to facilitate the reduction of closed fractures. It was described in the 1920s and is in common use worldwide. Haematoma block has been used effectively in patients as young as two years of age. It has the advantages of ease of administration, fast onset, long duration of fracture‐site analgesia, and it does not require specialised equipment. Haematoma block may be safely administered by a single doctor. It is unique in the ability to provide fracture‐site analgesia without sedation or cumbersome tourniquet, making it ideal for many medical retrieval situations. The safety of the technique makes it well suited to rural practice. The speed and minimal monitoring requirement enhances its utility in the busy urban emergency department.

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Haematoma block versus intravenous regional anaesthesia in Colles' fractures.

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Haematoma block versus intravenous regional anaesthesia in Colles' fractures.

Haematoma block or Bier's block for Colles' fracture reduction in the accident and emergency department--which is best?

OBJECTIVE: To offer clear guidance on the anaesthetic management of Colles' fractures in the accident and emergency (A&E) department in the light of the conflict between existing reports and current...

A prospective trial to compare three anaesthetic techniques used for the reduction of fractures of the distal radius

The aim of this study was to compare prospectively haematoma blocks alone and haematoma blocks with sedation with general anaesthesia for the reduction of distal radius fractures in adult patients, with respect to pain perception before, during and after manipulation using a visual analogue scale, radiological position, waiting time, procedure time and cost. Fifty-eight adult patients with closed, displaced distal radius fractures were included in the study. Pain experienced during manipulation was greatest in patients who received haematoma blocks alone compared with the other two groups. Post-manipulation pain was significantly greater in patients who received a general anaesthetic. Radiological correction was as good in those patients receiving a haematoma block with or without sedation as a general anaesthetic. The waiting and manipulation times and resource costs were greater in those receiving a general anaesthetic. There were no complications related to any of these anaesthetic methods. Patient acceptance is greater with a correctly performed haematoma block and sedation technique compared to general anaesthesia. It is also more efficient with regard to time and the resources required. This is particularly important for a progressively increasing ambulatory, elderly population who require prompt, safe, effective and painless management.

A tide of change in the management of an old fracture?

Colles' fractures are manipulated under a variety of anaesthetic techniques. An increasing awareness of cost and time within the National Health Service contributes to a marked change in the anaesthetic management of Colles' fractures. This paper presents the results of a survey of the anaesthetic techniques used in the larger accident and emergency (A&E) departments of the UK, and demonstrates the increasing popularity of the haematoma block compared with 5 years ago (7% in 1989 vs. 33% in 1994), at the expense of the general anesthetic (44% in 1989 vs 24% in 1994). The popularity of the Bier's block has remained unchanged (33% in 1989 and 1994). Local and regional anaesthetic techniques can be safely performed by A&E doctors, with appropriate monitoring, and this has beneficial resource implications for the anaesthetic department and the hospital.

Hematoma Block for Ankle Fractures: A Safe and Efficacious Technique for Manipulations

The purpose of this study was to examine the safety and efficacy of the hematoma block technique for closed ankle fracture manipulation. Twenty-three patients received a hematoma block with or without supplemental analgesia and/or sedation for the manipulative reduction of an ankle fracture, and 37 patients received parenteral agents alone. At an average of 12 months post-reduction, patients were administered a questionnaire concerning their level of discomfort surrounding the manipulation of their acute injury. Their experienced level of pain was recorded on a pain analog scale at the time of injury, at the time of reduction, and at the time of the questionnaire. Other queries were made regarding their recall of other aspects of their acute care treatment. The hematoma block group noted their pain differential to be 3.4 less during reduction compared with the time of injury. In the 17% subgroup of hematoma block patients who received no supplemental parenteral analgesia, the pain differential was noted to be 4.5 less during reduction. This was in contrast to the non-hematoma block group, which rated their pain differential to be 0.6 between injury and reduction. In addition, the hematoma block procedure resulted in no associated complications. The results of this study led us to conclude that the hematoma block with or without supplemental analgesia for the manipulation of ankle fractures was safe and effective and is a useful technique. This is particularly true in those patients in whom an adequate dosage of parenteral medication is contraindicated or unsafe.

Self-administered nitrous oxide and a hematoma block for analgesia in the outpatient reduction of fractures in children.

We prospectively studied the efficacy and safety of self-administered nitrous oxide combined with a hematoma block in 100 children who had a closed reduction of a fracture in the emergency department. No child was excluded from the study because of the type of fracture. The average Children's Hospital of Eastern Ontario pain score (CHEOPS), as determined by the emergency-medicine physician who observed the reduction, was 6.8 points (range, 4 to 12 points). The average grade for pain, as recalled by the patient and indicated on a visual-analogue pain scale that ranged from 0 to 10 points, was 6.5 points before the patient received any analgesia and 1.2 points immediately after reduction of the fracture and application of a cast. Ninety-seven patients obtained an analgesic effect from the combination of nitrous oxide and a hematoma block. The three remaining children obtained no effect, and the fracture was reduced with use of general anesthesia. Three additional reductions were technically unsuccessful because of rotational or angular malalignment, and a second reduction was performed with general anesthesia. There were no complications such as vomiting, respiratory depression, a change in the oxygen-saturation level, infection, or nerve injury. We concluded that self-administration of nitrous oxide combined with use of a hematoma block is a safe and effective technique of analgesia for the outpatient reduction of fractures in children.

Spinal epidural hematoma following epidural anesthesia versus spontaneous spinal subdural hematoma. Two case reports

Two cases of lumbar hemorrhage with subsequent persistent neurologic sequelae are presented and their possible causes are discussed in the context of a literature review: one patient with spontaneous spinal subdural hematoma with no trauma or lumbar puncture and one with spinal epidural hematoma associated with preceding epidural catheterization for postoperative pain relief. The subdural hematoma was associated with a thrombocytopenia of about 90,000/microliters due to intraoperative blood loss. This might have been contributory to the formation or expansion of the hematoma, but it is not convincing since a platelet count of this amount should not lead to spontaneous bleeding. Both patients received low-dose heparin, but since coagulation tests were normal, prolonged bleeding does not appear to be a likely cause, although it cannot be excluded. In conclusion, the reasons for both hematoma remain unclear. With regard to the epidural hematoma and low-dose heparinization, the possible coincidence of spontaneous lumbar hematoma and lumbar regional block should be taken into consideration.

Plasma lidocaine levels following hematoma block for distal radius fractures.

Venous plasma levels of lidocaine were determined in 8 patients presenting to the emergency department with acute distal radius fractures and who had had anesthesia with fracture hematoma block. The block was performed in an aseptic fashion via a dorsal approach with a dose of 2.2-2.4 mg/kg of lidocaine without epinephrine. Onset of anesthesia was in less than 5 min which reduced pain from manipulation of the fracture to modest levels. Plasma lidocaine levels determined by gas chromatography-mass spectrometry reflected rapid systemic absorption of lidocaine from the fracture hematoma. Maximum systemic concentrations were seen at 20-30 min and ranged from 100 to 1,100 ng/ml, well below the toxic threshold of 5,000 ng/ml.

Haematoma block for fractures of the wrist: a cause of compartment syndrome

A case of compartment syndrome after haematoma block for a fracture of the distal radius is reported. This seems to be the first report of this complication. A review of the literature revealed seven other cases of compartmental ischaemia reported after fracture of the distal radius, and a haematoma block was used in all the cases where the type of anaesthesia was known. It is suggested that the additional fluid added for a haematoma block can precipitate a compartment syndrome, which may be more common than the scarcity of cases reported would indicate.

Haematoma Block for Fractures of the Wrist: A Cause of Compartment Syndrome

A case of compartment syndrome after haematoma block for a fracture of the distal radius is reported. This seems to be the first report of this complication. A review of the literature revealed seven other cases of compartmental ischaemia reported after fracture of the distal radius, and a haematoma block was used in all the cases where the type of anaesthesia was known. It is suggested that the additional fluid added for a haematoma block can precipitate a compartment syndrome, which may be more common than the scarcity of cases reported would indicate.

Haematoma block—a safe method of reducing Colles' fractures

A total of 136 patients required an anaesthetic to enable distal fractures of the forearm to be reduced. There were no significant differences in the numbers requiring remanipulation between the three methods employed: haematoma block, Bier's block or general anaesthesia. The advantages of the haematoma block are discussed.

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Intravenous regional anaesthesia (IVRA) has been successfully used as a sole technique for forearm fractures and has high success rates. However, it is uncomfortable for the patient when the fresh fracture is manipulated for conduct of IVRA. Haematoma block (HB) has also been demonstrated as an effective anaesthetic technique for treatment of radial fractures in the ER. Unfortunately, HB does not provide muscular relaxation and may not be sufficient for operative intervention.An observational case series was designed with the hypothesis that a combination of HB and IVRA would overcome the aforementioned drawbacks. A standardized protocol was followed for HB with 0.1 ml/kg of 0.5% bupivacaine preceding the conduct of IVRA, which permitted adequate exsanguination of the extremity (using compression bandage). For IVRA, 0.5% lignocaine at 3 mg/kg was used with an electro-pneumatic tourniquet. Pain scores were noted after the HB, at exsanguination and during surgery.100 cases were studied. Average time of onset of block after HB was 2 min 18 s. By the time the IVRA procedure was performed, 99% of patients had a pain score of zero. The quality of surgical anaesthesia revealed that 94% of the patients did not have any pain of incision, tourniquet or positioning at any time during surgery.The use of dual technique of HB and IVRA improved patient acceptance and compliance, and the safety and efficacy of the IVRA. The combination anaesthesia was found to be easy to administer, effective and safe with no complications.