1. 2nd - 3rd September, 2011
Bangalore, INDIA
HAEMATOMA BLOCK
A BOON
IN AMBULATORY ORTHOPAEDIC SURGERY
Dr V.S.N.Raju
Hyderabad
drvsnraju@gmail.com
www.archospitals.com

2. HAEMATOMA BLOCK ----------------
2nd - 3rd September, 2011
Bangalore, INDIA A BOON IN AMBULATORY ORTHOPAEDIC SURGERY
aa
drvsnraju@gmail.com
www.archospitals.com

3. HAEMATOMA BLOCK ----------------
2nd - 3rd September, 2011
A BOON IN AMBULATORY ORTHOPAEDIC SURGERY
Bangalore, INDIA
AIM AND OBJECTIVE :-
( PATIENT SENARIO )
Meaningful means to curb many impediments in private hospital care -----
 Duration of hospitalization
 Cost of over all bill and expenditure
 Unfit physical condition for routine anaesthesia methods
 Reduction in chance of DVT in patients prone to it
 Adaptation & Modification of approved surgical techniques
 Easy for attendants
 Back to work with shorter absenteeism
 Post traumatic depressive psychosis

4. HAEMATOMA BLOCK ----------------
A BOON IN AMBULATORY ORTHOPAEDIC SURGERY
2nd - 3rd September, 2011
Bangalore, INDIA
Background to Study :-
 Quick bed turnover to hospital -- bed strength X frequency of occupancy
 Lack of awareness about health insurance and health policy
 Risk prone patients – age, disease, morbidity, co morbidity, etc.
 Avoidable prophylaxis for DVT in such prone cases
 Acceptance of modified techniques by proper / adequate counselling
 Routine of attendants is less disturbed in time and quality
 Much reduced compensation / absenteeism and back to work sooner
 Minimal or absence of post traumatic depressive psychosis observed

5. HAEMATOMA BLOCK ----------------
A BOON IN AMBULATORY ORTHOPAEDIC SURGERY
2nd - 3rd September, 2011
Bangalore, INDIA
Materials :-
Patients who are
 Employed and bread winners
 Dependant children and elderly
 Middle and low socio economic groups
 Rural or remote area dwellers
 Uninsured
Age group considered – 02 to 80 years
Gender sharing - 60% male in 02 to 50 years
66% female in > 50 years
Types of fractures – phalanges, metacarpals, forearm, metatarsals,

6. HAEMATOMA BLOCK ----------------
A BOON IN AMBULATORY ORTHOPAEDIC SURGERY
2nd - 3rd September, 2011
Bangalore, INDIA
Method :-
 Routine admission and pre operative evaluations are mandatory
 Informed consent and details of responsible attendant are mandatory
Detailed difference from routine procedure is explained by consultant,
anaesthesiologist, theatre staff to the patient and the attendant
 Cold compresses are applied all the while to reduce local exudative
reaction of any closed fracture from entry to reduction and stabilization
 2 % Lignocaine is used to anaesthetize the fracture by injecting into the
fracture haematoma under aseptic precautions, preferably under C-arm
control, in the O.R. to achieve pain-free satisfactory reduction.
 Appropriate slab or cast would be applied.
 Average time in hospital would be 2 to 10 hours. Longer in elderly
needing detailed evaluation

7. HAEMATOMA BLOCK ----------------
A BOON IN AMBULATORY ORTHOPAEDIC SURGERY
2nd - 3rd September, 2011
Bangalore, INDIA
Risks and Contra indications :-
 Status, orientation on presentation
 Subjects on DVT prophylaxis or anti-haemo coagulants like Warfarin
 Haemophiliacs', bleeding diathesis / tendencies
 Septic foci, else where
 Local skin condition from disease or trauma
 Extensive involvement of bony part – comminution, long spiral fractures
 Multiple sites involved – more than one bone
 Trauma about face, head injury

8. HAEMATOMA BLOCK ----------------
A BOON IN AMBULATORY ORTHOPAEDIC SURGERY
2nd - 3rd September, 2011
Bangalore, INDIA
Discussion :-
Haematoma block has not caused any adverse effects in our 15 year
observation, in any age group or physical status of any patient.
Pre operative evaluation and case selection are prime needs.
Cases rejected for routine anaesthesia – GA , may be considered for
Haematoma block, where risks are different.
In the elderly with wrist fractures Haematoma block comes very handy.
Pharmacology and pharmacokinetics of Lignocaine are not dicussed here in.

9. HAEMATOMA BLOCK ----------------
A BOON IN AMBULATORY ORTHOPAEDIC SURGERY
2nd - 3rd September, 2011
Bangalore, INDIA
Conclusion :-
Multi fold benefits of Haematoma do not condemn the routine practice of
Anaesthesiology, its significance or modesty.
The benefit a patient gets are immense with practice of haematoma blocks
in routine hospitals apart from day care centres
Advantages are beneficial for a hospital in quick bed occupancy turnover
and a satisfied patient and his peers would recommend others for
treatment of fractures by this novel procedure.
Thus, Haematoma Block finds an honoured place in
Ambulatory Surgery and its practice, as we observed.

10. 2nd - 3rd September, 2011
Bangalore, INDIA
HAEMATOMA BLOCK
IN AMBULATORY ORTHOPAEDIC SURGERY
We realize that it is a boon
to the practitioner and the beneficent
However, there need to be a standardization and guide lines to apply.

11. 2nd - 3rd September, 2011
Bangalore, INDIA
HAEMATOMA BLOCK
A BOON
IN AMBULATORY ORTHOPAEDIC SURGERY
Dr V.S.N.Raju
Hyderabad
drvsnraju@gmail.com
www.archospitals.com