Performing the block: Hip and Lower Extremity Flashcards
Femoral Nerve Block Landmarks: NAVEL
Nerve
Artery
Vein
Empty
Lymphatic
Lateral to medial
What is the superior border of the femoral triangle?
Inguinal ligament
What does the femoral nerve lie within?
fascia iliaca
The artery and vein do not reside in this compartment!!! (Quiz question)
Femoral Nerve Ultrasound Technique
- Palpate the femoral artery
- Place ultrasound parallel to the inguinal ligament
- Locate nerve lateral to artery (not compressible)
- Insert needle in-plane towards nerve until it is under the fascia iliaca ligament
- Inject 10-20mL of LA
Potential complications and side effects: Femoral Nerve Block
- Higher infection risk (espicially with catheter placement)
- Vascular puncture and hematoma (nerve compression)
- Prolonged motor blockade with fall risk
Fascia Iliaca block anatomy: Facia Iliaca compartment
2 layers
Lies between the
fascia iliaca
psoas muscle
What two fascial layers do we need to go through in the Iliaca block?
- Fascia lata (superficial)
- Fascia iliaca
What does the fascia iliaca block?
3
- lateral femoral cutaneous
- femoral
- obturator
Fascia Iliaca ultrasound insertion technique
- two pops (fascia lata and the fascia iliaca)
- Needle insertion lateral to the femoral nerve and superficial to the ilacus muscle
- Needle positioned further laterally than femoral nerve block
- Large amount of local is administered in the fascia ilaca plane
Fascia Iliaca: Infrainguinal verse Suprainguinal
- Infra: historically this was used but was not very effective
- Supra: new technique that more effectively gets the obturator
Suprainguinal fascia iliaca landmarks?
Abdominal muscle
Deep circumflex iliac artery
fascia iliaca
iliacus muscle
Superficial to deep
What is unzippering?
When the LA is injected the correct plane and it looks like it is being “unzipped”
Adductor Canal Block aka?
Saphenous Nerve Block
TKA block?
In the past we did femoral but that was a motor blockade so now they are using adductor canal with adjuct intraop LA placement
Ankle / Foot Block?
adductor canal with a popliteal adjunct for complete coverage