3.6 Fascia- Iliaca block

Question 1

Outline

indications FIB

Answer 1

Indications:

1. Femoral fracture analgesia
2. Analgesic adjunct for hip surgery
   - dorsal aspect - sciatic
3. Surgery anteromedially aspect thing
   - skin graft
4. Knee arthroscopy
   - combo sciatic N block
   intra-articular analgesia
5. TKR
   combo sciatic

Question 2

Contraindication to FIB

Answer 2

Abso
Patient refusal
LA allergy
Local infection

Rel;
Systemic sepsis
Coagulopathy
Local tumour contain tissue
ipsilateral pelvic renal tplx
LL neuro deficit

Question 3

Techniques

Answer 3

Hx + consent
SLIMRAG

Patient supine

1cm below
junction lateral and middle third inguinal ligament
(ASIS -> tubercle)

Plane identified 2 clicks
block needle passes
Lata / Iliaca

Question 4

Technique FIB

Answer 4

Negative aspiration
single shot 20-40ml LA
or catheter technique

Larger vol
block more cephalic branches
- tracing into psoas fascial plane

U/S tech
ID plane
confirm spread LA

Question 5

Advantage

Answer 5

1. No stimulator reqd
   More comfortable awake patient
2. Supine - no movement
3. Safely insert catheter - post op analgesia
4. Consistent block lateral fem cut and fem N
   vs 3in1
5. Better analgesia for hip surgery vs 3in1
6. Lack side effects vs central block

Question 6

Disadvantages

Answer 6

1. LA often fail block higher branches of lumbar plexus
2. Risk visceral + peritoneal injury
3. External iliac vessels relative close proximity
   - care avoid iv injection