Nerve Block: Fascia Iliaca Compartment: Difference between revisions
(Created page with "==Indication== *Indicated for isolated femur fractures, etc. Use: 1) Ropivacain (Natropin) 0.5% <20kg = 0.75mL/kg >20kg = 0.5 ML/kg *max - 30mL OR 2) Bupivicaine *Risk ...") |
ClaireLewis (talk | contribs) |
||
(17 intermediate revisions by 7 users not shown) | |||
Line 1: | Line 1: | ||
== | ==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== | ==Procedure== | ||
*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] | |||
==References== | |||
<References/> | |||
[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:Orthopedics]] |
Revision as of 16:43, 9 October 2019
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
- Perform thorough neurovascular exam prior to procedure
- Always calculate your anesthetic volume beforehand
- 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