EM:RAP Emergency Medicine: Reviews and Perspectives

2012  ›  February Episode

RANT: Iliaca Block

Its a femur fracture and you need some pain relief..What to do what to do?  EMRAP's Al Sacchetti sheds a little light.



  • Al Sacchetti, MDOur Lady of Lourdes Hospital Camden New Jersey

Comments on RANT: Iliaca Block

Kevin M.

During this type of presentation there should be an active link to follow while listening...Would be pretty easy..

Mel H.

What exactly are you thinking. Like a video link from within the iPod file?

Fen M., Dr

Ropivacaine is less cardiotoxic in accidental vascular injection - hence preferable to bupivacaine.

Jonathan T.

Any difference in peds vs adults landmarking?

Ian T., M.D.

I have been performing fasia-iliacal blocks for both hip and proximal femur fractures for a few years. I use ropivocaine. My blunt needle of choice is a caudal needle.

I consider these blocks to be standard of care for these patients. Great for the elderly in minimising the need for opioid analgesia and its inherent side effects. In fact one institution I have worked at did not allow patients with fractured NOFs to be transferred to the ward unless a regional block had been performed in ED (unless specific contra-indications were present).

Douglas L.

The biggest clinical hurdle I have found to doing all kinds of blocks (femoral, median, digital, etc) has been with my consultants. They often are PISSED when I do blocks before they see the patient, even if I document a thorough neurovascular exam before doing so. Even if they have seen the patient, they usually prefer for the nerves not to be blocked subsequently. I understand this to some degree, as nerve injuries are not uncommon with various fractures. Also, if internal or external fixation is going to be done, they want to know whether a problem was caused during manipulation. Has anyone else run into this?

Torree M., M.D.

I'm having the same problem as Douglas above. One of our docs did a nerve block on a hip fracture and my orthopods had a fit. How have people gotten around this issue? Any hints on how to come up with a workable solution?

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