Ultrasound-guided Fascia Iliaca Blocks

A discussion of the fascia iliaca block, my chosen alternative - the out-of-plane femoral nerve block, and principles underlying the choice of technique, as well as hip analgesia in general. Recommended videos of suprainguinal fascia iliaca blocks at • How to perform ultraso... and • Short clip showing fas...

[@KiJinnChin]

00:48 - Evolution of the fascia iliaca block
03:40 - Out-of-plane femoral nerve block as a preferred alternative
05:11 - Technique of the out-of-plane suprainguinal femoral nerve block
06:46 - Insertion of a catheter for continuous nerve block
07:34 - Clinical considerations in RA for hip analgesia
10:08 - Transverse IP infra-inguinal fascia iliaca block (not recommended)
10:38 - Longitudinal IP supra-inguinal fascia iliaca block
12:11 - Summary / Conclusion

[@Chemelilful]

OOP Femoral nerve block 10ml with needle directed cranial first and then SIFIB into the clearly visible and open fascia iliac plain is a game changer for me.

[@ahmedelgamassy4567]

Do you continue to the Supra inguinal region from the same femoral puncture point or do another cranial puncture?

[@gc3134]

Excelent Dr. K.J.Chin, that variant is a better reference than lateral aproach to see the needle under the fascia iliaca, and spread de LA to create a path for the needle is very creative. Thanks.

[@ahmetmuratyayik5731]

This presentation has answered many questions in my mind, thank you professor for this excellent video.

[@RashidHussainOfficialMusic]

Great Insight .

[@shawlyndean5288]

Excellent explaination

[@ThisAllSoundsGood]

Excellent explanation, diagrams, and videos. I also use this OOP-to-IP approach for PIVs and arterial lines.

[@KiJinnChin]

Yes - so do I! OOP ensures you come right down on the vessel so it doesn't slide away from the needle, and the IP view then allows you to ensure you have the right trajectory and don't pierce the back wall. Thanks for the comment!

[@fathisaleh5146]

Very good Explained thank you for uploading this education material which helps Anesthesiologist and Patient as well

[@JUSSTTIINFU3K]

10:15 well done for speaking some sense and challenging this.

[@spjm11]

At 6:37, is that the LFCN in the middle of the screen directly above and out of the fascial plane?

[@iaroslavvodolaga8170]

thank you very much, professor. Very useful.

[@wugiz]

@kijinnchin and what about these RA methods for urgent thrombectomy in femoral artery? Which one you would choose?

[@tobiastemann8295]

perfect job, thank you very much (also the rest of your videos, everything very well explained and highly interesting, uptodate resources!)
- question: how does the PENG block fit into this variety of approaches? esp., do you think it is possible to get the AON and the LCFN reliable into one technique (esp. interesting for continuous postop. analgesia)? Thanks in advance for a reply!

[@tobiastemann8295]

mmmh? still open and hot question, at least in my mind. would love to read your thoughts on it

[@ahmedelgamassy4567]

Thanks for your nice work that I am a very big fan of.
Do you think QLB 3 for hip surgery analgesia can be effective ?
Thanks

[@KiJinnChin]

I have never deliberately done it. It could be effective - it may depend how lateral to the tip of the TP you are; because the lumbar plexus diverges more anteriorly the more lateral you go. So this lowers the probability of LA reaching the LP. The question to ask yourself is why you would choose it over other techniques.

[@ahmedelgamassy4567]

@@KiJinnChin Thanks a lot. You are right, The QLB would be with very unpredictable effect.

[@erickim1830]

@kijinnchin great video. Is it possible deposition of local anesthetic farther away from femoral nerve (bowtie or J Gadsden's approach) decreases incidence/intensity of motor block via differential sensory block (a la QL for abdominal surgery; or Lumbar ESP for spine surgery)? This may have useful in an outpatient setting to facilitate PT on POD0, prior to the advent of PENG; but a moot point if using fascia iliac for inpatient hip fracture (instead of ambulatory total hip arthroplasty)

[@KiJinnChin]

Yes, I think that differential block based on distance of deposition from target nerves is a valid point. May also explain why lumbar plexus blocks were used for a long time in total hip replacements, seemingly without much concern for dense motor block. Your reasoning regarding appropriate use of blocks for a given context is also sound and in line with my thinking.

[@erickim1830]

@@KiJinnChin Am curious if you feel differential block is the reason behind analgesic efficacy of high-volume (30 ml) adductor, likely due to indirect spillover to Femoral nerve). As well as quadriceps palsy risk in slender patients BMI < 25.

[@vcuheel1464]

What is your go to block for hip arthroscopy at an outpatient surgery center? Would you do this block or a PENG block?

[@KiJinnChin]

Hip arthroscopy is complicated with regards to pain etiology, and unpredictable. PENG would address capsule pain, but pain may also be muscular, e.g. from traction or fluid extravasation. If immediate weight-bearing and quads function not required, femoral/FI block might cover more bases.

[@vcuheel1464]

@@KiJinnChin Thanks for the quick reply! I do think that quad function is valuable in the outpatient setting where many hip scopes don’t involve repairs and can be quick and often not that painful.