Procedure: Haematoma Block

The Procedure

Hello again from the Emergency Procedures team,

Hematoma Block

This week we cover a practical alternative to sedation for fracture reduction — the haematoma block. Simple, effective, and resource-sparing, it has become a core ED skill.

Detailed written instructions and explanation are available here and in our Free App (iOS and Android). This video is hot off the press and we want your help improving it. Drop us a line with any suggestions

So, without further ado…here is the video

The rationale…

Why use a haematoma block instead of sedation?

It provides excellent pain control, avoids the resource demands of procedural sedation, and allows earlier discharge. Large studies show equivalent reduction quality, high first-attempt success rates, and fewer complications compared to sedation

How effective is it for pain relief?

Analgesia is very effective both during and after reduction. Multiple trials and reviews confirm similar or superior pain control compared to sedation

What impact does it have on ED flow?

Haematoma block is associated with shorter procedure times and reduced ED length of stay, improving overall efficiency

Is it safe?

Adverse events are rare. Infection, local anaesthetic toxicity, and compartment syndrome have been reported, but very infrequently. By contrast, sedation carries more common risks such as apnoea, hypotension, and nausea

Does ultrasound improve success?

Not usually required, but it can help in multi-fragment fractures or when landmarks are unclear. It may increase confidence in placement, though standard landmark technique is effective in most cases

Are other alternatives worth considering?

Other approaches such as circumferential periosteal blocks and brachial plexus blocks are under investigation, but haematoma block remains the proven, practical technique for ED use.

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