Updates

Figure 1: Needle insertion for the fascia iliaca block. The black dot indicates the position of the femoral artery.

 Indications: anterior thigh and knee surgery, analgesia following hip and knee procedures

 Transducer position: transverse, close to the femoral crease and lateral to the femoral artery (black dot)

 Goal: medial-lateral spread of local anesthetic underneath fascia iliaca

 Local anesthetic: 30-40 mL of dilute local anesthetic (e.g., 0.2% ropivacaine)

Fascia iliaca block is a low-tech alternative to a femoral nerve or a lumbar plexus block. The mechanism behind this block is that the femoral and lateral femoral cutaneous nerves lie under the iliacus fascia. Therefore, a sufficient volume of local anesthetic deposited beneath the fascia iliaca, even if placed some distance from the nerves, has the potential to spread underneath the fascia and reach these nerves. Traditionally, it was believed that the local anesthetic could also spread underneath fascia iliaca proximally toward the lumbosacral plexus; however, this has not been demonstrated consistently. The non-ultrasound technique involved placement of the needle at the lateral third of the distance from the anterior superior iliac spine and the pubic tubercle, using a "double-pop" technique as the needle passes through fascia lata and

Nerve injury following peripheral nerve blockade (PNB) is a potentially devastating complication that can result in permanent disability. (1) Data from a recent review of published studies suggest that the incidence of neurologic symptoms following PNB varies depending on the anatomic location, ranging from 0.03% for supraclavicular blocks to 0.3% for femoral blocks to up to 3% for interscalene blocks. (2) Fortunately, the vast majority of these neuropathies appear to be temporary rather than permanent neuropathy and resolve over weeks to months.

The exact etiology of neurologic injury related to PNB remains unclear in many instances. Suggested etiologies include mechanical trauma from the needle, nerve edema and/or hematoma, pressure effects of the local anesthetic injectate, and neurotoxicity of the injected solutions (both local anesthetics and adjuvants, e.g., epinephrine). (3) Confounding factors that may play a role in nerve injury include preexisting neuropathies (e.g., diabetes mellitus), surgical manipulation, prolonged tourniquet pressure, or compression from postoperative casting. (4)

It is well-established that direct injection into peripheral nerves (i.e., accidentally during intramuscular administration) can result in nerve injury. (5) This is one of the reasons why intraneural injections are avoided during peripheral nerve blockade. More recent data however, suggest that