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).
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?
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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Episode 125Full episode audio for MD edition243:28 min - 102 MB - M4AC3 Project Written Summary: Asthma, Pneumothorax and ARDS107 KB - PDFEM:RAP February Written Summary1 MB - PDF
Kevin M. - February 11, 2012 12:20 PM
During this type of presentation there should be an active link to follow while listening...Would be pretty easy..
Mel H. - February 19, 2012 7:59 PM
What exactly are you thinking. Like a video link from within the iPod file?
Fen M., Dr - February 21, 2012 1:10 AM
Ropivacaine is less cardiotoxic in accidental vascular injection - hence preferable to bupivacaine.
Jonathan T. - March 28, 2012 6:55 PM
Any difference in peds vs adults landmarking?
Ian T., M.D. - May 11, 2012 11:04 PM
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. - May 21, 2012 1:37 AM
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. - April 15, 2015 1:15 PM
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?