Fascia Iliaca Block – ACP teaching

Pre-Cousre teaching on Fascia Iliaca Block

Slide show – HERE

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

  1. Observable Cubical
  2. Cardiac Monitor
  3. Obs: 5, 10, 15, 30 min

8. Local Anaesthetic Toxicity  – here

 

Further reading

Leave a Reply

Your email address will not be published. Required fields are marked *

20 − nine =

This site uses Akismet to reduce spam. Learn how your comment data is processed.