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.
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.
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.
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.
It certainly minimizes the risk of
neurovascular injuries, as the landmark is more lateral than for a femoral
nerve block.
As far as effectiveness of the block is
concerned, I am somewhat sceptical.
I had good results, but also a number of
complete failures, despite 100% happiness with the technique.
I know, this is only anecdotal medicine,
rather than EBM.
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.
It is a myth that this nerve-stimulator
guided block is poorly tolerated on awake patients.
Some time ago, we wanted to do a three-arm
study, comparing conventional iv opioids vs FICB vs nerve stimulator guided FNB.
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.
Maybe there are people out there who have
more stamina than me, and who will do it?!
However, I claim to have an idea of which
of the regional blocks is going to be more consistently successful.
If it was my hip – definitely nerve-stimulator
guided FNB.
Regards,
Niels Merkel
Worthing
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?
|
Authors |
|
|
Institution |
Department of Orthopaedics, |
|
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. |