Nerve Block: Fascia Iliaca Compartment: Difference between revisions

Latest revision as of 06:34, 8 May 2021

Indications

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

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

^Should see effect in <10 min

Complications

Bleeding/hematoma
Infection
Intravascular injection

External Links

References

Authors:

@@ Line 1: / Line 1: @@
-==Indication==
+==Indications==
-*Femur fracture
+*[[Femur Fracture]]
 *[[Hip Fracture]]
-==Contraindication==
+==Contraindications==
+*Infection overlying injection site
 *Presence of femoral vascular grafts (relative)
-==Medications==
+==Equipment Needed==
-*Ropivacaine (Natropin) 0.5%
+*Local anesthetic
-**<20kg = 0.75mL/kg
+*Syringe with blunt fill needle and 27ga needle
-**>20kg = 0.5 ML/kg
+*Chloraprep
-**^max - 30mL
-OR
-*Bupivacaine 0.5%
-**studies in adults have used 25 mL of 0.5% bupivacaine or 30 mL of 0.25% bupivacaine
-**Modify based on toxic level by weight
 ==Procedure==
-*Perform good neurovascular exam prior to procedure
+[[File:Femoral_Nerve_block_anatomy.png|thumb|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
+===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
+*Place probe in transverse on thigh, just inferior to inguinal ligament 1/3 of way from anterior superior iliac spine to the pubic tubercle
-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
@@ Line 30: / Line 28: @@
 *Confirmation = visualizing an expanding anechoic collection just below the fascia iliaca
-Landmark technique
+===Landmark technique===
-# Point = 2/3 laterally along line between ant/sup iliac spine and pubis
+#Point = 2/3 laterally along line between ant/sup iliac spine and pubis
 ##i.e. sig lateral to nerve
-# 90 deg angle with 22Ga needle (spinal needle)
+#90 deg angle with 22Ga needle (spinal needle)
-# 2 "pops" through fascial planes (1 inch max)
+#2 "pops" through fascial planes (1 inch max)
-# Withdraw to check not in vessel
+#Withdraw to check not in vessel
-# Apply pressure 1 inch caudally accross thigh
+#Apply pressure 1 inch caudally accross thigh
-# Infuse drug
+#Infuse drug
-# Hold pressure on thigh for 2 minutes
+#Hold pressure on thigh for 2 minutes
 ##to encourage cephalad spread
@@ Line 44: / Line 42: @@
 ==Complications==
+*Bleeding/hematoma
+*Infection
 *Intravascular injection
-**Risk of cardiac depression if injected intravascularly
-**Ultrasound guidance mitigates this risk
-*Hematoma
-*Use fall precautions for patient
-*Case reports exist nerve blocks obscure detection of compartment syndrome. This has not held up in studies.
-==Source==
+==See Also==
-/07 DONALDSON (adapted from EM Annals 8/07)
+*[[Nerve blocks (main)]]
+*[[Local anesthetic systemic toxicity]]
-Wedel DJ, Horlocker TT.  Miller's Anesthesia. 7th ed. pp. 1652-1655.
+==External Links==
+*[http://emergencymedicineireland.com/2014/05/anatomy-emergency-medicine-028-fascia-iliaca-block/ Anatomy for EM - Fascia Iliaca Block]
+*[https://www.youtube.com/watch?v=p6X0IiYolIk Video: Fascia Iliaca Block]
-Haines L, Dickman E, Ayvazyan S, et al. Ultrasound-guided fascia iliaca compartment block for hip fractures in the emergency department. J Emerg Med. 2012;43(4):692–7.
+==References==
+<References/>
-Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. Am J Emerg Med. 2010;28(1):76–81.
-Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013;20(6):584–91.
 [[Category:Procedures]]
+[[Category:Orthopedics]]