View source for 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==
[[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===
*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==
*Bleeding/hematoma
*Infection
*Intravascular injection

==See Also==
*[[Nerve blocks (main)]]
*[[Local anesthetic systemic toxicity]]

==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]

==References==
<References/>

[[Category:Procedures]]
[[Category:Orthopedics]]