Fascia iliaca block explained

Fascia iliaca block
Synonyms:	fascia iliaca nerve blockade, fascia iliaca compartment blockade, femoral intercutaneal nerve blockade

Fascia iliaca blocks (FIC, FICB) is a local anesthetic nerve block, a type of regional anesthesia technique, used to provide analgesia or anaesthesia to the hip and thigh. FICB can performed by using ultrasound or with a loss of resistance technique, the latter sometimes referred to as the "two-pop-method".^[1] FICB works by affecting the femoral, obturator and the lateral cutaneous nerves with a local anesthetic.^{[2] [1]}

Technique

When FICB is performed with the loss of resistance technique, the injection site for FICB is found by drawing an imaginary line between the pubic tubercle to the anterior superior iliac spine. The injection site is 1 cm. below the lateral one third and the medial two thirds of this line. Two losses of resistances are felt as the fascia lata and the fascia iliaca is penetrated by a semi-blunt cannula. Aspiration (drawing back the cannula) is performed, after which a local anaesthetic is injected while compressing on the skin distally to increase cranial distribution.^{[1] [3]} FICB can generally be performed with minimally required training and by non-medical practitioners^[2]

Medical uses

FIC can be used to offer pain relief for hip fractures in adults^{[2] [4] [5]} and femoral fractures in children.^[6]

Adverse effects

FIC is generally safe to use and have few adverse effects. There is a 0.09-3.2% risk of hematomas at the injection site and a 0.18% risk of local anaesthetic intoxication.^[2] There are also case reports of pneumoretroperitoneum using continuous infusion,^[7] bladder puncture with a modified block under very special conditions^[8] and postoperative neuropathy.^[9]

History

The block was first described in 1989 as an alternative to 3-in-1 nerve block in children.^[3]

See also

• Femoral nerve block
• Lidocaine

Notes and References

1. Mallinson. Tom. Fascia iliaca compartment block: a short how-to guide. Journal of Paramedic Practice. 11. 4. 2019. 154–155. 1759-1376. 10.12968/jpar.2019.11.4.154.
2. Steenberg. J.. Møller. A.M.. Systematic review—effects of fascia iliaca compartment block on hip fractures before operation. British Journal of Anaesthesia. 120. 6. 1368–1380. April 2018. 10.1016/j.bja.2017.12.042. 29793602. free.
3. Dalens. B. Vanneuville. G. Tanguy. A. Comparison of the fascia iliaca compartment block with the 3-in-1 block in children.. Anesthesia & Analgesia. December 1989. 69. 6. 705–13. 2589650. 10.1213/00000539-198912000-00003. free.
4. Chesters. A. Atkinson. P. Fascia iliaca block for pain relief from proximal femoral fracture in the emergency department: a review of the literature.. Emergency Medicine Journal. October 2014. 31. e1. e84–7. 10.1136/emermed-2013-203073. 24389648.
5. Pinson. S. Fascia Iliaca (FICB) block in the emergency department for adults with neck of femur fractures: A review of the literature.. International Emergency Nursing. October 2015. 23. 4. 323–8. 10.1016/j.ienj.2015.03.002. 25956668.
6. Black. Karen JL. Bevan. Catherine A. Murphy. Nancy G. Howard. Jason J. Nerve blocks for initial pain management of femoral fractures in children. Cochrane Database of Systematic Reviews. 12. CD009587. 17 December 2013. 10.1002/14651858.CD009587.pub2. 24343768.
7. Shelley. Benjamin G.. Haldane. Grant J.. Pneumoretroperitoneum as a Consequence of Fascia Iliaca Block. Regional Anesthesia and Pain Medicine. 1 November 2006. 31. 6. 582–583. 10.1016/j.rapm.2006.08.009. 17138203. en. 1098-7339.
8. Blackford. D. Westhoffen. P. Accidental bladder puncture: a complication of a modified fascia iliaca block.. Anaesthesia and Intensive Care. January 2009. 37. 1. 140–1. 19157368.
9. Atchabahian. A. Brown. AR. Postoperative neuropathy following fascia iliaca compartment blockade.. Anesthesiology. March 2001. 94. 3. 534–6. 11374619. 10.1097/00000542-200103000-00029. free.