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Fascia Iliaca Compartment Nerve Block: Difference between revisions
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{{Ported|source=[https://wikem.org/wiki/Nerve_Block:_Fascia_Iliaca_Compartment WikiEM]|license=CC-BY-SA|license-link=https://creativecommons.org/licenses/by-sa/4.0/}} | {{Ported|source=[https://wikem.org/wiki/Nerve_Block:_Fascia_Iliaca_Compartment WikiEM]|license=CC-BY-SA|license-link=https://creativecommons.org/licenses/by-sa/4.0/}} | ||
==Indications== | ==Indications== | ||
* | *Femur Fracture | ||
* | *Hip Fracture | ||
==Contraindications== | ==Contraindications== | ||
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==Equipment Needed== | ==Equipment Needed== | ||
*Local | *Local anaesthetic | ||
*Syringe with blunt fill needle and 27ga needle | *Syringe with blunt fill needle and 27ga needle | ||
*Chloraprep | *Chloraprep | ||
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[[File:Femoral_Nerve_block_anatomy.png|thumb|Cartoon of pertinent anatomy in femoral nerve block]] | [[File:Femoral_Nerve_block_anatomy.png|thumb|Cartoon of pertinent anatomy in femoral nerve block]] | ||
*Perform thorough neurovascular exam prior to procedure | *Perform thorough neurovascular exam prior to procedure | ||
*Always calculate your | *Always calculate your anaesthetic 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]]. | **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 | *This block requires more volume than the standard femoral nerve block | ||
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*Visualize fascia lata and iliaca as 2 hyperechoic lines | *Visualize fascia lata and iliaca as 2 hyperechoic lines | ||
*Introduce 22 gauge spinal needle lateral to medial, parallel to transducer | *Introduce 22 gauge spinal needle lateral to medial, parallel to transducer | ||
*After puncturing through fascia iliaca, infiltrate a small volume of the | *After puncturing through fascia iliaca, infiltrate a small volume of the anaesthetic solution. Should see the fascia lift up off of the nerve. Continue to infuse anaesthetic. | ||
*Confirmation = visualizing an expanding anechoic collection just below the fascia iliaca | *Confirmation = visualizing an expanding anechoic collection just below the fascia iliaca | ||
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#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 | #Apply pressure 1 inch caudally across thigh | ||
#Infuse drug | #Infuse drug | ||
#Hold pressure on thigh for 2 minutes | #Hold pressure on thigh for 2 minutes | ||
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*Infection | *Infection | ||
*Intravascular injection | *Intravascular injection | ||
==External Links== | ==External Links== |
Latest revision as of 21:51, 4 May 2022
Indications
- Femur Fracture
- Hip Fracture
Contraindications
- Infection overlying injection site
- Presence of femoral vascular grafts (relative)
Equipment Needed
- Local anaesthetic
- Syringe with blunt fill needle and 27ga needle
- Chloraprep
Procedure
- Perform thorough neurovascular exam prior to procedure
- Always calculate your anaesthetic 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 anaesthetic solution. Should see the fascia lift up off of the nerve. Continue to infuse anaesthetic.
- 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 across 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