Haematoma Block – Colles’

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]

Asepsis

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)

Method

a. Insertion

  • 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
  • Aspirate
  • 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)

 

ENP’s – DOP’s forms can be found here

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