Pre-Cousre teaching on Fascia Iliaca Block
1. Cautions and Contraindications
- Cautions
- Anticoagulation (Warfarin OR NOAC) – not a contraindication but caution is required, due to the risks of nerve damage
- Requires other blocks (e.g. Haematoma) – Fascia Iliaca Block is a high volume block consider a Femoral Nerve Block.
- Proceeding Opiates – an effective block can potentiate opiate effects
- Contraindications
- Patient Refusal
- Allergy/Anaphylaxis
- Inflammation/Infection at site
- Previous By-Pass surgery OR near graft site
2. Consent – must be recorded
Potential risks
- Intravascular Injection
- Local Anaesthetic Toxicity
- Nerve Damage (Temp/Perm)
- Infection
- Block Failure – (DON’T repeat)
- Allergy
- Injury due to leg weakness/numbness
3. Kit
You and your helper will need your recommended PPE + sterile gloves
- Ultrasound
- Chlorhexadine 0.5% – (2% Chlorhexidine is neuro toxic)
- Tegaderm – (large)
- Aqua Gel – (sterile)
- Nerve Block Needle
- Drawing up needle
- 20ml Syringe x2
4. Anaesthetic [Anaesthesia UK]
- Drug: Levobupivicaine 0.25% (2.5mg/ml)
- MAX Dose: 2.5 mg/kg
- MAX Volume: 1ml/kg
- Recommended Volumes (Adults):
- 30-50kg – 30ml
- >50kg – 40ml
5. STOP before you BLOCK!!!
- Correct patient?
- Correct leg?
6. Ultrasound Guided FIB
- Hold probe lateral – under the inguinal ligament
- Identify the structures – esp. the fascia planes and artery
- Needle is inserted – just under the Fascia Iliaca and above the Iliacus muscle
- Aspirate prior to injection – if there is blood reposition and recheck prior to injection
- While injecting – Stop if there is high resistance
7. Monitoring
Peak Absorption/Effect: 15-30min
- Observable Cubical
- Cardiac Monitor
- Obs: 5, 10, 15, 30 min
8. Local Anaesthetic Toxicity – here