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Fascia Iliaca Compartment Block for Hip Fractures

Jessica Mason, MD and Danielle Campagne, MD
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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EMRAP_2018_09_September_Written Summary 440 KB - PDF

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Daniel S. -

Great talk; this is a long standing technique in the UK and Australia, where I work. I thought I'd share some hints:

I use a larger bore needle to infiltrate the local bleb, usually an 18G, to purposefully create a larger entry point.
I then use a BLUNT needle, connected to a short IV extension set, connected to a 20 ml syringe, and go through the initial entry point.
The blunt needle allows the tactile sensation of the 2 "pops" as you penetrate the fascia iliaca and fascia lata.
The IV extension allows you to have more control of the placement of the needle, without the weight of the 20 ml syringe.

Hope that helps!

Danielle C., MD -

Hi, thank you for this feedback! Recently I have been using your described technique and I agree that it works great! I really like the short extension tubing you mentioned and we have added it to our FICB kit in our own ED. Thanks for the tips!

Yves G. -

0,5 % marcaïne would give me 10 cc max dose in a 100 kg pt if my calcul is good ! You do what to have the volume recommended ? Dilute it in NS ?

Jess Mason -

Yes, this was a bit unclear and we added some additional clarification soon after publication. Whatever concentration of bupivacaine you have you have to calculate the maximum safe dose. 2 mg/kg of bupivacaine is a conservative number for max dose, with the max adult dose being 175 mg. This is using the patient's ideal body weight, not actual. As you're suggesting, you can dilute it in NS to give you enough volume so it can spread the fascial plane.

Sarah W. -

I think it's inaccurate to describe bupivicaine as "safer," and to say it has an antidote. Lidocaine has a wider therapeutic index and is less cardiotoxic. While bupivicaine toxicity can be treated with intralipid, it doesn't directly reverse the action of local anesthetics like an antidote, and it's not near 100% effective. As mentioned in the edit and by Dr. Mason above, it's critically important to calculate the maximum dose you can give the patient, and what volume of your solution that translates to.

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EM:RAP 2018 September Full episode audio for MD edition 213:30 min - 313 MB - M4AEM:RAP 2018 September Canadian Edition Canadian 25:37 min - 35 MB - MP3EM:RAP 2018 September German Edition Deutsche 99:49 min - 137 MB - MP3EM:RAP 2018 September French Edition Français 21:59 min - 30 MB - MP3EM:RAP 2018 September Aussie Edition Australian 39:22 min - 54 MB - MP3EM:RAP 2018 September Spanish Edition Español 78:35 min - 108 MB - MP3EMRAP 2018 08 Sept Individual MP3 277 MB - ZIPEMRAP 2018 09 Sept Board Review Answers 130 KB - PDFEMRAP 2018 09 Sept Board Review Questions 238 KB - PDFEMRAP 2018 September Summary (SPA) 763 KB - PDFEMRAP 2018 09 September Individual Summaries 765 KB - ZIPEMRAP_2018_09_September_Written Summary 440 KB - PDF

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