3 nerves in 1 injection.
30ml 0.5% bupivacaine (less in small/ frail/ elderly) plus 10ml saline,
makes up 40 ml, easier in two 20ml syringes. This is good for the fractured
NOF and should last for hours. It takes at least half an hour so you'd need
lignocaine for a quicker effect for fractured shaft of femur.
The key is distal pressure to prevent the anaesthetic spreading distally, it
should go proximally to reach the obturator and lateral cutaneous nerves.
Injecting feels easier than injecting into a vein. If it starts to bulge
under the skin you're in the wrong place and too superficial. Venflon or
widish needle 1-2cm lateral to the femoral artery. Cannot claim to always
feel the pop-pop.
Usually helps. The injection doesn't seem to sting much either.
James Cameron.
----- Original Message -----
From: "Dr Mandar Marathe" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, March 29, 2006 7:03 PM
Subject: Re: fascia iliaca block for hip fractures
> Hi,
>
>> '3-in-1' blocks usually work very well
>
> Can I ask what exactly is a 3-in-1 block?
>
> Does it mean 10ml lignocaine + 10ml bupivicaine + 10ml water (to make up
> volume) or does it refer to the 3 nerves which are blocked in 1 go -
> femoral
> lat. cutaneous nerve of thigh, obturator.
>
> Also, is the procedure any different from a standard femoral block?
>
> Thanks
>
> Mandar.
>
>
>
> ----- Original Message -----
> From: "James Cameron" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Wednesday, March 29, 2006 12:26 PM
> Subject: Re: fascia iliaca block for hip fractures
>
>
>> Agree that '3-in-1' blocks usually work very well (Initially taught to me
> by
>> Ffion Davies) but occasional disappointing results despite seeming OK
>> when
>> you do them. Our SHOs now doing them for fractured NOFs.
>
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