Fascia Iliaca Compartment Block

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/

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.

Is there a good or recommended method to determine depth when doing the blind technique?