Haematoma blocks can be a safe and effect method of pain relief to facilitate reducing Colles’ fractures.
What to give?
- 1% Lidocaine
- Onset 10-15min
- Offset up to 2hr
- 3mg/kg (maximum dose)
- 70kg patient could have up to 210mg
- Volume 1% Lidocaine = 10mg/ml
- 70kg = 210mg / 10 = 21ml
- Signs of TOXICITY
Sensory Disturbance: Facial tingling, Numbness, Metallic taste, Tinnitus, Vertigo
Functional Disturbance: Slurred speech, Seizures, Reduced GCS
Cardiovascular: Hypotension, Palpitations
- Treatment – ABCD, see LA-Toxicity [HERE]
Remember you are putting a needle into a sterile fracture and bone infection never ends well.
- Chloro prep or Betadine – ensure it has time to dry
- Sterile field
- Sterile Gloves (particularly when learning)
- No-Touch technique (Only if proficient)
- Find fracture site – move approx. 1cm proximally
- Insert needle – bevel down & at approx. 30°, towards the fracture
- Hit bone & slide – forward into the fracture
- Aspirate – you should be able to aspirate some blood, but not always (however, its should not flow too easily, if it does are you in a vessel?)
- Inject – this often needs a bit of pressure, infiltrate approx. 1/4 of the volume.
b. Fanning (this is not always necessary but seems to improve outcome)
- Withdrawal needle a little – keeping it under the skin.
- Change angle & advance – into the fracture
- Aspirate and Infiltrate – more lidocaine
- Repeat – do this several times so you have walked needle across the fracture (Use approx. 1/2 the lidocaine)
c. Ulna styloid (Only needed if fracture or tender)
- Find Ulna styloid
- Insert needle – straight onto the styloid
- Inject – you are not normally going into the fracture but leaving a bolus approx.1/4
Give the patient 10-15min while you set up for reduction for it to achieve peak effect – then check how its working. (getting the patine to move their wrist is a good test)