I usually don't use a nerve stimulator for nerve blocks, having seen an
anaesthetist many years ago cause great agony to a patient with a nerve
stimulator as the muscle contractions pulled on the fracture.
Has nerve stimulator technology moved on? Or is it simply a function of
the amount of current used? Can you get a muscle twitch without moving
the fracture?
Tim.
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of
[log in to unmask]
Sent: 28 March 2006 22:34
To: [log in to unmask]
Subject: Re: fascia iliaca block for hip fractures
Our Orthopoodles are planning an optimisaton protocol for these patients
and are including this block in the ED phase. Wheras I am ever eager to
learn new stuff, I was keener to get stimulator controlled femoral block
embedded. I have just got my first two boxes of needles!
>
>Well, I have some experience in performing this block in people who
come through the door with a #NOF, and the occasional #shaft of femur.
>
>
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>I discovered this technique while I was doing a refresher session in
theatres. Our anaesthetists now swear by it, and do it for a variety of
elective and emergency OPs around the hip, femur and knee.
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>It is certainly easy to do. It just needs a blunt needle, e.g. the one
used in theatres to draw up drugs from vials. Alternatively, some people
use a Tuohy needle.
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>The main principle is, that a blunt needle gives you the desired
feedback as to when the fascial planes are pierced. As the penetration
of the two fascias (lata & iliaca) is quite obvious, we also call it the
'pop-pop' block.
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>It certainly minimizes the risk of neurovascular injuries, as the
landmark is more lateral than for a femoral nerve block.
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>As far as effectiveness of the block is concerned, I am somewhat
sceptical.
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>I had good results, but also a number of complete failures, despite
100% happiness with the technique.
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>I know, this is only anecdotal medicine, rather than EBM.
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>My personal gold standard for analgesia in #NOF and #shaft of femur
remains a nerve stimulator guided femoral nerve block. This technique is
now firmly established in our department. If you get anterior quadriceps
contractions at the correct threshold (which is possible in, I'd say,
95% of patients) then this block has RELIABLE & PREDICTABLE success.
>
>Agreed - it takes more time than the FICB and needs an assistant, which
can be a factor in a busy ED, but this time to my experience is
well-spent for the patient.
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>It is a myth that this nerve-stimulator guided block is poorly
tolerated on awake patients.
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>Some time ago, we wanted to do a three-arm study, comparing
conventional iv opioids vs FICB vs nerve stimulator guided FNB.
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>We felt slightly put off by the amount of paperwork, that now seems to
be needed these days in order to get a project like this off the ground
- so it didn't happen.
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>Maybe there are people out there who have more stamina than me, and who
will do it?!
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>However, I claim to have an idea of which of the regional blocks is
going to be more consistently successful.
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>If it was my hip - definitely nerve-stimulator guided FNB.
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>Regards,
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>Niels Merkel
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>Worthing Hospital
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>Worthing
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>
>From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Ray
>Sent: 28 March 2006 18:57
>To: Niels Merkel
>Subject: fascia iliaca block for hip fractures
>
>
>
>
>
>Does anyone have any experience of fascia iliaca block for hip
fractures?
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>Ray McGlone
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>Authors
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>Candal-Couto JJ. McVie JL. Haslam N. Innes AR. Rushmer J.
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>Institution
>
>Department of Orthopaedics, Wansbeck General Hospital, Ashington,
Northumbria NE63 9JJ, UK.
>
>Title
>
>Pre-operative analgesia for patients with femoral neck fractures using
a modified fascia iliaca block technique.
>
>Source
>
>Injury. 36(4):505-10, 2005 Apr.
>
>Local Messages
>
>Held at BMA Library
>
>Abstract
>
>Adequate pre-operative analgesia for elderly patients with femoral neck
fractures is difficult to assess and is often an overseen aspect of
their care. We aimed to assess the efficacy of fascia iliaca blocks
inserted via plexus blockade catheters in the pre-operative period. Our
simple technique allowed the block to be administered safely without the
need for a nerve stimulator. We assessed the effectiveness of the block
with a novel objective sitting score and by assessing the degree of
passive hip flexion that could be achieved comfortably. Visual analogue
scores were also used. We studied 30 consecutive patients, regardless of
their mental state. One hour following the block, there was a
significant improvement in the sitting scores as well as the passive hip
flexion (mean increase 44 degrees ). Visual analogue scores also score
improved significantly from 7.2 to 4.6 (S.D. 2.4) in the 18 patients
without cognitive impairment. We conclude that fascia iliaca blocks can
provide significant benefit in the pre-operative period and allow
patients to sit up more comfortably while they await surgery.
>
>Publication Type
>
>Journal Article.
>
>
>
>
>
>_______________________________________________________________________
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