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

• RCEM – fascia Iliaca Block Guide 2020
• Systematic Review of Fascia Iliaca blocks