Nerve Block: Fascia Iliaca Compartment: Difference between revisions
No edit summary |
No edit summary |
||
| Line 1: | Line 1: | ||
==Indication== | ==Indication== | ||
*Femur fracture | |||
*[[Hip fracture]] | |||
==Contraindication== | |||
*Presence of femoral vascular grafts (relative) | |||
==Medications== | ==Medications== | ||
*Ropivacaine (Natropin) 0.5% | |||
**<20kg = 0.75mL/kg | |||
**>20kg = 0.5 ML/kg | |||
**^max - 30mL | |||
<20kg = 0.75mL/kg | |||
>20kg = 0.5 ML/kg | |||
^max - 30mL | |||
OR | 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 | |||
*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 | # Point = 2/3 laterally along line between ant/sup iliac spine and pubis | ||
##i.e. sig lateral to nerve | ##i.e. sig lateral to nerve | ||
# 90 deg angle with 22Ga needle | # 90 deg angle with 22Ga needle (spinal needle) | ||
# 2 "pops" through | # 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 | ||
| Line 31: | Line 42: | ||
^Should see effect in <10 min | ^Should see effect in <10 min | ||
==Complications== | |||
*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== | ==Source== | ||
8/07 DONALDSON (adapted from EM Annals 8/07) | 8/07 DONALDSON (adapted from EM Annals 8/07) | ||
Wedel DJ, Horlocker TT. Miller's Anesthesia. 7th ed. pp. 1652-1655. | |||
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. | |||
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:Procedures]] | ||
Revision as of 00:20, 22 September 2013
Indication
- Femur fracture
- Hip fracture
Contraindication
- Presence of femoral vascular grafts (relative)
Medications
- Ropivacaine (Natropin) 0.5%
- <20kg = 0.75mL/kg
- >20kg = 0.5 ML/kg
- ^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
- 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
- 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
- to encourage cephalad spread
^Should see effect in <10 min
Complications
- 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
8/07 DONALDSON (adapted from EM Annals 8/07)
Wedel DJ, Horlocker TT. Miller's Anesthesia. 7th ed. pp. 1652-1655.
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.
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.