HEMATOMA BLOCK

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Slide 1:

REDUCTION AND MANNIPULATION OF COLLE’S FRACTURE UNDER HEMATOMA BLOCK Dr.SREENIVASARAO, MD,CCPPM , ASSIST PROFESSOR, DEPT OF ANAESTHESIOLOGY, S.V.R.R.G.G.H & S.V.M.C, TIRUPATHI.

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PATIENT DETAILS : A MALE PATIENT, P.V.GURUMURTHY, AGED ABOUT 50yrs, MET WITH RTA & CAME TO THE HOSPITAL WITH C/O SWELLING OVER THE RIGHT WRIST DEFORMITY OF THE RIGHT WRIST

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VITAL DATA PULSE RATE -82/mt BLOOD PRESSURE-120/80 mm of hg CVS-S1,S2+ RS-BILATERAL AIR ENTRY GOOD OTHER SYSTEMS NORMAL

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INVESTIGATIONS HB :10gm% BT :1’.11” CT :2.’55” BLOOD GROUP :B Positive BLOOD SUGAR :110mg% BLOOD UREA :26mg% SEERUM CREATININE :0.8 ECG,CHEST X-RAY -NORMAL

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X-RAY RIGTH WRIST

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PREANAESTHETIC EVALUATION KNOWN DIABETIC SINCE 10yrs, PATIENT IS ON ORAL HYPOGLYCEMICS ie.,TAB DIONIL OD RANDOM BLOOD SUGAR 110mg% OTHER HISTORY NILL SIGNIFICANT

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PREPARATION OF THE PATIENT LIDOCAINE SENSITIVITY TEST DONE PROCEDURE EXPLAIN TO THE PATIENT IV ACCESS SECURED MONITORS PULSE RATE OXY.SATURATION, NIBP CONNECTED PREMIDACATION Ing.MIDAZOLAM-1mg Ing.RANTAC Ing.ONDENSETRAN

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DRUG & EQUIPMENT LIDOCAINE 2% 2CC FOR LOCAL INFILTRATION LIDOCAINE 1% FOR HEMATOMA BLOCK DISPOSABLE SYRINGES 2CC,10CC POVIDONE IODINE (7.5%), SPIRIT STERILE DRAPES

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PROCEDURE PAIN WAS ASSESED BY VAS -8/10 PT WAS SHIFTED TO THE OT, LIE DOWN IN SUPINE POSITION, IV LINE WAS SECURED MONITORS WERE CONNECTED BLOCK SITE CLEANED WITH BETADINE & SPIRIT BLOCK SITE WAS COVERED WITH STERILE DRAPES

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PROCEDURE CONT …….. 2CC, 2% LIDOCAINE WAS INJECTED ALONG THE PATHWAY OF INJECTION 10CC SYRINGE WITH 22GAUGE NEEDLE FILLED WITH 10CC 1%LIDOCAINE, NEEDLE WAS PLACED AT THE FRACTURE HEMATOMA SITE WHICH WAS DETERMINED BY ASPIRATING 1-2-CC OF HEMATOMA BLOOD BARBATAGE WAS DONE WITH HEMATOMA BLOOD AND 20CC LIDOCAINE AFTER 10mts PAIN WAS ASSESED BY VAS SORE ie.,<1/10 THEN REDUCTION AND MANNIPULATION WAS DONE POP APLLIED TO STABLISE THE JOINT

HEMETOMA BLOCK:

HEMETOMA BLOCK

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DISCUSSION HEMATOMA- IS AN EXTRAVASATION OF BLOOD OUT SIDE THE BLOOB VESSELS HEMATOMA BLOCK- INJECTING THE LOCAL ANAESTHETIC IN TO THE HEMATOMA TO BLOCK THE PERIOSTEAL PAIN AT THE FRACTURE SITE

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INDICATIONS A CLEAN ,CLOSED FRACTURE SITE DISTAL RADIUS FRACTURE ANKLE FRACTURE etc DISTAL FRACTURES CONTRAINDICATIONS CONTAMINATED WOUNDS OPEN FRACTURES XYLOCAINE SENSITIVITY YIUNG CHILDREN

ADVANTAGES:

ADVANTAGES SIMPLE, SAFE, EFFECTIVE DAY CARE PROCEDURE CAN AVVOID THE MULTIPLE DRUG USAGE AND COMPLICATIONS CAN ALSO DONE AT CASUALITY IT IS VERY CHEAP SIMPLE PROCEDURE ,CAN BE PERFORMED BY ORTHOPEDICIANS AND CAN SAVE THE RESOURSES

DISADVANTAGES:

DISADVANTAGES WE CAN NOT PERFORM IN OPEN WOUNDS CAN’T PERFORM IN LIDOCAINE SENSITIVITY PATIENTS IF YOU CAN NOT DONE UNDER STERILE CONDITIONS CHANCES OF INFECTION IS MORE

COMPARITIVE STUDIES:

COMPARITIVE STUDIES Singh G K, Manglik R K, Lakhtakia P K, Singh A. Analgesia for the reduction of Colles fracture. A comparison of hematoma block and intravenous sedation. Online J Curr Clin Trials 1992 Oct 1; Doc No.23 ( s ) PAIN SCORE DURING REDUCTION FOR HB GROUP WERE ACCEPABLY LOW <W(MEDIAN 1.8) AND IV SEDATION UNACCEPTABLY HIGH >3(MEDIAN 8.7) : Furia J P, Alioto R J, Marquardt J D. The efficacy and safety of the hematoma block for fracture reduction in closed, isolated fractures. Orthopedics 1997 May; 20(5): 423-6 ( s ) PAIN DIFFERNTIAL SCORE 0.8 FOR HB GROUP AND 2.7 FOR NON HB GROUP

STUDIES CONT…………..:

STUDIES CONT………….. The Efficacy Of The Hematoma Block For Fracture Reduction In The Distal Forearm Fractures: A Double Blind Randomized Controlled Trial --Suraj Bajracharya et al The Internet Journal of Anesthesiology™ ISSN: 1092-406X Pain during reduction- same in HBgroup and BPB group Quality of reduction was found to be more in HB group comparitively to BPB group Complications were nill in HB group but in BPB group 1/50 developed bronchospasm needing intubation &icu care

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