Ultrasound Guided Fascia Iliaca Block

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

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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

Dr. Ozaki presents today’s Morning Report!

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.
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