Dr. Ozaki presents today’s Morning Report!
Ultrasound-Guided Fascia Iliaca Block
*Consider this as an adjunct for pain control in patients with hip fractures.
Fascia Iliaca is located anterior to the iliacus muscle
-Femoral and lateral cutaneous nerves lie under fascia iliaca
-Injecting anesthetic under the fascia will allow the anesthetic to spread and reach these nerves to provide analgesia
Nerve Distribution and blockade
-Femoral nerve: anesthesia of anterior and medial thigh, also contributes to articular fibers to both hip and knee
-Lateral femoral cutaneous nerve: cutaneous innervation to anterolateral thigh
Technique
-Approximate site of needle placement will be at the lateral 1/3 of the line connecting the ASIS to the pubic symphisis
-Place the ultrasound transducer in the transverse plane in the inguinal region to identify the femoral artery and nerve, iliioosoas muscle and fascia iliaca
-Transducer is moved laterally until Sartorius muscle is identified
-Needle is then introduced in-plane
-Continue to advance needle till it passes just under the fascia iliaca (may feel two “pops”)
-Inject 1-2 cc to confirm placement of needle under fascia
-Once placement confirmed, may require 30-40 mL of anesthetic to achieve adequate blockade
Advantages
-decreases use of opioids for pain control
Does it really work?
-Study of 63 patients that underwent fascia iliaca block had reduction in pain scores at 15 min, 2 hours, and 8 hours, no systemic complications noted
-In another study pain scores were measured at 0, 10 min, 20 min, 30 min, 60 min, 120 min, 240 min and 480 min
- Statistically significant reduction in pain scores at all time points
- Max efficacy at 120 min with 76% reduction in pain scores
- 80% did not require additional analgesia; the 4 that asked for more pain medications did so after 120 min
References:
- Monzon D et al. “Single Fascia Iliaca Compartment Block for Post-Hip Fracture Pain Relief.” The Journal of Emergency Medicine. April 2007. 32(3): 257-262.
- Haines L et al. “Ultrasound-Guided Fascia Iliaca Compartment Block for Hip Fractures in the Emergency Department.” The Journal of Emergency Medicine. October 2012. 43(4): 692-697.
- http://www.nysora.com/updates/3107-ultrasound-guided-fascia-iliaca-block.html
Jay Khadpe MD
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