Ultrasound-Guided Fascia Iliaca Block ( Supra-inguinal Technique)
Nerves Blocked: Femoral nerve, lateral cutaneous nerve of thigh +/- obturator nerve
Location: Below fascia iliaca to block branches of lumbar plexus
Difficulty: Green/ Blue
Indications: Fractures of hip & proximal femur. Surgery on hip, anterior thigh & knee
Patient Position: Supine
Needle: 50-100mm short beveled regional block needle
Probe: High frequency linear
Tiger Territory: Bowel
Femoral vessels
Think Twice if: Previous vascular surgery in ipsilateral groin
Image optimisation: Screen depth 3 - 5 cm
Ultrasound probe perpendicular inguinal ligament
Scan along the inguinal ligament
Best image is usually just off the anterior superior iliac spine
Needling: In-Plane
• Caudad to cephalad/medial direction (enable cephalad spread local anaesthetic)
• Needle tip should be positioned just under the fascia iliaca.
Complications/ SEs: Higher risk of local anaesthetic toxicity (as large volumes local anaesthetic used)
Pearls: Larger volumes will achieve greater spread of local anaesthetic and coverage of nerves
• Use a minimum of 30ml in an adult
• Dilute the concentration as necessary to keep within a safe dose of local anaesthetic
When injected in correct position fascia iliaca should peel away from the iliacus muscle
Catheter insertion is useful for continuous infusion of local anaesthetic, or intermittent boluses