How to perform Fascia Iliaca Blocks at Zion and SDMC

Indication:

Hip Fractures

Consent

Infection, Bleeding, Arterial Puncture, Nerve Injury, Neuro or Cardiotoxicity from systemic absorption of anesthetic (see more below)

Preparation

Anesthetic options for nerve blocks.

Anesthetic options for nerve blocks.

Preferred anesthetic: Ropivicaine 0.5% - 2.5mg/kg

Order ropivicaine to bedside (RN can draw from pyxis) - I typically choose the Ropivicaine SQx1 and then change to Intra-articular and put in dosing.

Draw up ropivicaine in 60ml syringe and diluate with normal saline.

Example, patient weighs 60kg. Ropivicaine dose is 150mg = 30ml of a 0.5% solution. Draw up 30ml in 60cc syringe and dilute with 20-30ml of normal saline.

Attach 60ml syringe to tubing and connect to spinal needle or tuohy needle.

We have pre-made nerve block kits in the Zion work room and the SDMC B pod with all of the necessary equipment:

Materials

Obtain a 60cc syringe, extension tubing and a 20g spinal.

Obtain a 60cc syringe, extension tubing and a 20g spinal.

Connecting the syringe to the needle via extension tubing allows you to have complete control over the needle while guiding it with ultrasound. A second operator can push the anesthetic.

Connecting the syringe to the needle via extension tubing allows you to have complete control over the needle while guiding it with ultrasound. A second operator can push the anesthetic.

Ultrasound

Identify landmarks on ultrasound

Notice that the fascia lata runs superficial to the sartorius muscle while the fasicia iliaca runs below the sartorius but above the iliopsoas towards the femoral nerve, artery and vein.

Notice that the fascia lata runs superficial to the sartorius muscle while the fasicia iliaca runs below the sartorius but above the iliopsoas towards the femoral nerve, artery and vein.

Ultrasound image showing similar anatomy

Ultrasound image showing similar anatomy

Ultrasound image showing another example of anatomy.

Ultrasound image showing another example of anatomy.

The fascia iliaca can be visualize below the sartorius traveling towards the femoral artery.

The fascia iliaca can be visualize below the sartorius traveling towards the femoral artery.

Example video clip showing surveillance of anatomy and insertion of a needle laterally through the sartorius muscle and through the fascia iliaca. In this example hydrodissection is utilized to help the operator visualize the exact location of the needletip in relation to the tissue layers.

DON’t FOrget

Place patient on telemetry during procedure and for 30 minutes after procedure to monitor for arrhythmias - necessary for large volume blocks.

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Documentation

Use the .fasciailiacablock dot phrase in Epic and fill out all fields.

Evidence

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Online Tutorials

http://5minsono.com/ficb/

Anesthesia Dosing for Other Nerve Blocks

Fascia Iliaca: 45-60cc (use anesthetic max dose & dilute up with saline)

Femoral nerve block: 15-20cc

Posterior tibial: 3-5cc

Sciatic: 15-20cc

Forearm nerves: 5-10cc per nerve

Greater auricular: 2cc

Most peripheral single nerves: 3-5cc

PECS/Serratus Anterior: 30cc 

TAP/Abdominal wall: 30cc