How to perform Fascia Iliaca Blocks at Zion and SDMC
Infection, Bleeding, Arterial Puncture, Nerve Injury, Neuro or Cardiotoxicity from systemic absorption of anesthetic (see more below)
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:
Identify landmarks on ultrasound
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.
Place patient on telemetry during procedure and for 30 minutes after procedure to monitor for arrhythmias - necessary for large volume blocks.
Use the .fasciailiacablock dot phrase in Epic and fill out all fields.
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
Forearm nerves: 5-10cc per nerve
Greater auricular: 2cc
Most peripheral single nerves: 3-5cc
PECS/Serratus Anterior: 30cc
TAP/Abdominal wall: 30cc