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