Nerve Block: Fascia Iliaca Compartment

Indications

• Femur Fracture
• Hip Fracture

Contraindications

• Infection overlying injection site
• Presence of femoral vascular grafts (relative)

Equipment Needed

• Local anesthetic
• Syringe with blunt fill needle and 27ga needle
• Chloraprep

Procedure

Cartoon of pertinent anatomy in femoral nerve block

• Perform thorough neurovascular exam prior to procedure
• Always calculate your anesthetic volume beforehand
  • Larger volumes of more dilute solution are better for plane blocks. 20 mL of 0.5% lidocaine is better than 10 mL of 1.0% lidocaine.
• This block requires more volume than the standard femoral nerve block

Ultrasound guided technique

• High frequency linear probe covered with sterile tegaderm
• Sterile surgilube
• Place probe in transverse on thigh, just inferior to inguinal ligament 1/3 of way from anterior superior iliac spine to the pubic tubercle
• Visualize fascia lata and iliaca as 2 hyperechoic lines
• Introduce 22 gauge spinal needle lateral to medial, parallel to transducer
• After puncturing through fascia iliaca, infiltrate a small volume of the anesthetic solution. Should see the fascia lift up off of the nerve. Continue to infuse anesthetic.
• Confirmation = visualizing an expanding anechoic collection just below the fascia iliaca

Landmark technique

1. Point = 2/3 laterally along line between ant/sup iliac spine and pubis
   1. i.e. sig lateral to nerve
2. 90 deg angle with 22Ga needle (spinal needle)
3. 2 "pops" through fascial planes (1 inch max)
4. Withdraw to check not in vessel
5. Apply pressure 1 inch caudally accross thigh
6. Infuse drug
7. Hold pressure on thigh for 2 minutes
   1. to encourage cephalad spread

^Should see effect in <10 min

Complications

• Bleeding/hematoma
• Infection
• Intravascular injection

See Also

• Nerve blocks (main)
• Local anesthetic systemic toxicity

External Links

• Anatomy for EM - Fascia Iliaca Block
• Video: Fascia Iliaca Block