Fascia iliaca block

Fascia iliaca blocks (FIC, FICB) is a local anesthetic nerve block, a type of local anesthesia, used for the hip and thigh. FIC can performed by using ultrasound or with a loss of resistance technique, the latter sometimes referred to as the "two-pop-method". FIC works by affecting the femoral, obturator and the lateral cutaneous nerves with a local anesthetic.[1]

Fascia iliaca block
Other namesfascia iliaca nerve blockade, fascia iliaca compartment blockade, femoral intercutaneal nerve blockade

Technique

When FIC is performed with the loss of resistance technique, the injection site for FIC is found by drawing an imaginary line between the pubic tubercle to the anterior superior iliac spine. The injection site is 1 cm. below the lateral one third and the medial two thirds of this line. Two losses of resistances are felt as the fascia lata and the fascia iliaca is penetrated by a semi-blunt cannula. Aspiration (drawing back the cannula) is performed, after which a local analgesic is injected while compressing on the skin distally to increase cranial distribution.[2] FIC can generally be performed with minimally required training and by non-medical practitioners[1]

Medical uses

FIC can be used to offer pain relief for hip fractures in adults[1][3][4] and femoral fractures in children.[5]

Adverse effects

FIC is generally safe to use and have few adverse effects. There is a 0.09-3.2% risk of hematomas at the injection site and a 0.18% risk of local anaesthetic intoxication.[1] There are also case reports of pneumoretroperitoneum using continuous infusion,[6] bladder puncture with a modified block under very special conditions[7] and postoperative neuropathy.[8]

History

The block was first described in 1989 as an alternative to 3-in-1 nerve block in children.[2]

See also

References
  1. Steenberg, J.; Møller, A.M. (April 2018). "Systematic review—effects of fascia iliaca compartment block on hip fractures before operation". British Journal of Anaesthesia. 120 (6): 1368–1380. doi:10.1016/j.bja.2017.12.042. PMID 29793602.
  2. Dalens, B; Vanneuville, G; Tanguy, A (December 1989). "Comparison of the fascia iliaca compartment block with the 3-in-1 block in children". Anesthesia & Analgesia. 69 (6): 705–13. doi:10.1213/00000539-198912000-00003. PMID 2589650.
  3. Chesters, A; Atkinson, P (October 2014). "Fascia iliaca block for pain relief from proximal femoral fracture in the emergency department: a review of the literature". Emergency Medicine Journal. 31 (e1): e84–7. doi:10.1136/emermed-2013-203073. PMID 24389648.
  4. Pinson, S (October 2015). "Fascia Iliaca (FICB) block in the emergency department for adults with neck of femur fractures: A review of the literature". International Emergency Nursing. 23 (4): 323–8. doi:10.1016/j.ienj.2015.03.002. PMID 25956668.
  5. Black, Karen JL; Bevan, Catherine A; Murphy, Nancy G; Howard, Jason J (17 December 2013). "Nerve blocks for initial pain management of femoral fractures in children". Cochrane Database of Systematic Reviews (12): CD009587. doi:10.1002/14651858.CD009587.pub2. PMID 24343768.
  6. Shelley, Benjamin G.; Haldane, Grant J. (1 November 2006). "Pneumoretroperitoneum as a Consequence of Fascia Iliaca Block". Regional Anesthesia and Pain Medicine. 31 (6): 582–583. doi:10.1016/j.rapm.2006.08.009. ISSN 1098-7339. PMID 17138203.
  7. Blackford, D; Westhoffen, P (January 2009). "Accidental bladder puncture: a complication of a modified fascia iliaca block". Anaesthesia and Intensive Care. 37 (1): 140–1. PMID 19157368.
  8. Atchabahian, A; Brown, AR (March 2001). "Postoperative neuropathy following fascia iliaca compartment blockade". Anesthesiology. 94 (3): 534–6. doi:10.1097/00000542-200103000-00029. PMID 11374619.
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