This Powerpoint presentation demonstrates the practical aspects of Fascia iliaca block which is widely recommended for pain control following injury or operation of hip, groin, thigh and knee.

1. Fascia iliaca block
Dr A Barai
MBBS, MRCS, MSc (Critical Care)
Locum Registrar in Emergency Medicine

2. What is Fascia Iliaca Block?
• It is a compartment block
• Initially demonstrated by Dalen et al.
• It blocks femoral nerve and lateral cutaneous nerve of the
thigh
• It provides good analgesia from groin to the knee

3. Advantages
• Good compartment nerve block from hip to knee
• Significant reduction of the requirement of Morphine
• Reduced rate of Deep Vein Thrombosis (DVT)
• Early mobilisation post-operatively
• Low-skilled, inexpensive and effective technique

4. Indications
• Perioperative analgesia for fracture of neck of femur
• Perioperative analgesia for fracture of shaft of femur
• Minor surgery in extensor compartment of thigh
• Adjuvant anaesthesia for above knee amputation
• Knee surgery in conjunction with Sciatic nerve block

5. Contraindications
• Patient refusal
• Infection or inflammation to the groin
• Allergy to local anaesthetic agents
• Certain skin condition in the groin
• Septic arthritis of the hip joint
• Previous femoral bypass surgery

6. Anatomy

7. Anatomy

8. Equipments
• Levobupivacaine 0.25% 30-40ml
• Lidocaine 1% 5ml
• Syringes 20mlX 2, 5mlX 1
• Blunt or short bevelled needle or Fascia iliaca block needle
• Chlorprepe
• Gloves
• Sterile dressing pack

9. Identification of landmarks
• Mark junction between lateral one third and medial two
thirds of a line joining anterior superior iliac spine and pubic
tubercle.
• 1-3cm vertically inferior to the previous mark is the point of
insertion of needle for fascia iliaca block
• Make a little mark at this point

10. Landmarks

11. Landmarks

12. Technique
Explain to the patient
Verbal consent
Aseptic precautions
Ask assistant to hold skin fat of abdominal wall in case
of pendulous abdomen
Put 2ml of Lidocaine to make a bleb

13. Technique
Hold the needle bevelled at 60° to horizontal plane
Hear and feel ‘pop pop’ as the needle pierces skin,
superficial fascia, fascia lata and fascia iliaca
Administer Levobupivacaine. There should be a free flow
At the end, take the syringe out. Keep needle in to see
backflow of Levobupivacaine
Cover the injection site with sterile gauze
Thank the patient, chaperone/ assistant

14. Pitfalls
• Failure of nerve block: usually due to poor technique
• Infection: due to lack of aseptic precautions
• Injury to the nerve, muscle, blood vessels
• Penetrating injury to the pelvic organs

15. Practical Tips
• Explain to the patient about the procedure
• Find the landmarks carefully: ASIS, pubic tubercle
• Use of ultrasound may help in identifying fascial planes
• Angle the needle backwards and cranially
• Hear and feel ‘pop pop’ as the needle penetrates through
fascia lata and fascia iliaca

16. Practical Tips
• If there is resistance during administration of local
anaesthetic agents, slowly pull the needle a little bit and try
administering local anaesthetic agent again
• Large volumes are required to achieve good analgesia-
usually 30-50ml
• Place manual pressure inferior to the injection site so that
the local anaesthetic agent can flow cranially

17. References
• Candal-Couto, J. 2005. Pre-operative analgesia for patients with femoral neck fractures
using a modified fascia iliaca block technique Injury, Int. J. Care injured 36, 505-510.
• Foss, N. 2007. Fascia iliaca compartment blockade for acute pain control in hip fracture
patients Anaesthesiology V 106, No 4, pp 773-8.
• Lopez, S. 2003. Fascia Iliaca Compartment Block for femoral bone fractures in prehospital
care. Regional Anaesthesia and Pain Medicine Vol 28, No3, pp 203-207.
• Monzon, D. 2007. Single Fascia iliaca compartment block for post-hip fracture pain relief.
The J of Emergency Medicine, Vol 32, No 3, pp:257-262.
• Range, C. and Egeler, C. 2010. Fascia Iliaca Compartment Block. Anaesthesia Tutorial of the
week 193. Online. URL:
http://www.frca.co.uk/Documents/193%20Fascia%20Iliaca%20compartment%20block.pdf
(Last accessed on 2nd January 2013).
• Taiwan Pain Society. The Fascia Iliaca Compartment Block. URL:
www.pain.org.tw/upload/11_The_Fascia_Iliaca_Compartment_Block.ppt. (Last accessed:
3rd January 2013).

18. Thank you
Any questions, suggestions or complements:
drbarai@gmail.com