Nerve Block: Fascia Iliaca Compartment

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
  • 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

  1. Point = 2/3 laterally along line between ant/sup iliac spine and pubis
    1. i.e. sig lateral to nerve
  2. 90 deg angle with 22Ga needle (spinal needle)
  3. 2 "pops" through fascial planes (1 inch max)
  4. Withdraw to check not in vessel
  5. Apply pressure 1 inch caudally accross thigh
  6. Infuse drug
  7. Hold pressure on thigh for 2 minutes
    1. to encourage cephalad spread

^Should see effect in <10 min

Complications

  • Bleeding/hematoma
  • Infection
  • Intravascular injection

See Also

External Links

References