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Nerve Block: Fascia Iliaca Compartment
From WikEM
Contents
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
- 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
