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

Observable Cubical
Cardiac Monitor
Obs: 5, 10, 15, 30 min

8. Local Anaesthetic Toxicity – here

9. Unable to Block?

Our aim within the ED is to offer a Block to ALL NoF patients. However in some cases such as Anticoagulated patients there is a relative contraindication to performing a Block and the ED senior may decide that we are unable to perform this within the ED. In these cases:

If you have a #NoF patient who you feel we wont be able to offer a Never Block in ED (please escalate to)

Monday to Friday 0900-1700 please call theatre 5 and ask for the consultant anaesthetist of the day. (they are often doubled up)
Weekend and OOH call the CEPOD anaesthetist. -LIMITED USEFULLNESS
- Unfortunately this is a junior who probably cant do blocks themselves
- However if their consultant is in they might be able to help , (but not all of them can do block)

You should receive a decision from anaesthetics promptly <30min as to weather this will be possible