Nerve Block: Fascia Iliaca Compartment: Difference between revisions
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==Contraindications== | ==Contraindications== | ||
*Infection overlying injection site | |||
*Presence of femoral vascular grafts (relative) | *Presence of femoral vascular grafts (relative) | ||
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==Complications== | ==Complications== | ||
*Bleeding/hematoma | |||
*Infection | |||
*Intravascular injection | *Intravascular injection | ||
==See Also== | ==See Also== |
Revision as of 11:09, 9 August 2015
Indications
Contraindications
- Infection overlying injection site
- Presence of femoral vascular grafts (relative)
Equipment Needed
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 thorough 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
- Bleeding/hematoma
- Infection
- Intravascular injection
See Also
External Links
Anatomy for EM - Fascia Iliaca Block
References
- 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.