In this short video we review the anatomy and approach to a fascia iliaca compartment block, which aims to block the femoral nerve, obturator nerve, and lateral femoral cutaneous nerve (also called a 3 in 1 block). This is a great block for patients with fractures of the femoral neck, intertrochanteric fractures, or proximal femur fractures. Pain is better controlled with nerve blocks and less opiates are required when this approach is used for hip fractures. This can be done with ultrasound guidance, or with a blind technique. Once the needle is through the fascia lata and fascia iliaca, the anesthetic is injected to dissect the iliacus muscle off the fascia iliaca, and the anesthetic tracks proximally up the fascial plane to anesthetize all 3 nerves (at least in theory!).
Garrett B. - September 8, 2018 2:19 PM
Prior to doing the procedure, it is important to ensure you have 20% Intralipid at your facility in the event of local anesthetic systemic toxicity - especially since you're going to be using bupivacaine. These patients can have seizures and go into cardiac arrest due to effect lidocaine and bupivacaine on sodium channels Make sure you know the symptoms of local anesthetic systemic toxicity. http://rebelem.com/local-anesthetic-systemic-toxicity-last/
Robert A. - January 24, 2019 6:01 PM
Could not agree more. Knowing what to do when things go wrong is the most important part of any procedure.
Abbas F. - September 22, 2018 12:18 AM
This video demonstrates femoral nerve block, not the fascia iliaca block (how it has been described using ultrasound guidance). Blind technique for the 3 in 1 block is the double "pop" technique where you inject anaesthetic next to femoral nerve and apply distal pressure, hoping that it would track up proximally and anaesthetise the obturator nerve and lateral cutaneous nerve of thigh. Distal pressure can also be applied after ultrasound guided LA injection which may improve the efficacy. Even with ultrasound, this method with distal pressure gives variable results.
A different method has been described for USS guided fascia iliaca compartment block. The primary landmark for initial probe placement is the ASIS, parallel to midline. Then you move your probe up and down, looking for what has been described as the "bow tie" appearance of the transition point between iliacus and sartorius muscles and deposit your desired volume of LA under the fascia iliaca, hydro-dissecting the iliacus away from the facia iliaca. This works quite nicely and is my usual practice now for all NOF fractures in ED.
Victor C. - June 20, 2019 9:21 AM
Agree w/ this comment. Could you do a video and show technique for fascia iliaca compartment block w/ US probe placed parallel to midline? I find the most difficult step is finding the 'bow tie' sometimes.
John U. - October 10, 2018 6:50 AM
Is there a good or recommended method to determine depth when doing the blind technique?