In Warwick we do Fasica Iliaca blocks for fractures and also for reduction of dislocation. Only two of us (myself and our registrar) doing them with any frequency at the moment. Always under US guidance. (Reason only two of us are doing them is we've got an old scanner and only two of us are happy using it). Anaesthetists don't do them. Could be argued you could do them blind with a blunt needle but there is still a risk of the needle slipping out of plane. Ultrasound guidance makes them a lot easier and the success rate is high. If I'm going blind I'll go for a femoral or 3 in 1 block. This is probably just down to what I'm used to: I did a lot of femoral and 3 in 1 blocks before I ever used an ultrasound scanner, but only came across fascia iliaca blocks a few years back.

 

We don't use the echogenic US needles. Means you can't be certain of the postion of the needle when you start injecting, but you can see if the fluid is going into the right plane.

 

I think if we had a better scanner it wouldn't take long to get the permanent medical staff all confident in placing these blocks under US guidance. Not every department has permanent medical staff on site 24/ 365, but FNOFs and prosthesis dislocation are generally daytime problems so you'd probably be able to cover a substantilal majority of cases. It's also one of the things (other than seriously ill patients) I don't mind coming in on call to do. Doesn't take long, helps the patient, helps the department, lets me do a bit of training and gets the staff more used to them.

 

Matt Dunn

 

 

 

2. The use of 3 in 1 / fascia iliaca blocks is gaining popularity. The evidence seems to suggest that we should be doing these under US guidance.

a) Are any departments doing these as a standard of care?

b) Is it ED or anaesthetics personnel that are doing them?

c) Have any departments been pushing this under US guidance?

A good best-bet was done on this topic http://bestbets.org/bets/bet.php?id=1024 but the real crux of the issue seems to be related to implementation and capacity building in departments with junior docs and poor staffing.

 

 

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