1. Cautions and Contraindications
- Cautions
- Anticoagulation (Warfarin OR NOAC) – not a contraindication but caution is required, due to the risks of nerve damage
- Requires other blocks (e.g. Haematoma) – Fascia Iliaca Block is a high volume block consider a Femoral Nerve Block.
- Proceeding Opiates – an effective block can potentiate opiate effects
- Contraindications
- Patient Refusal
- Allergy/Anaphylaxis
- Inflammation/Infection at site
- Previous By-Pass surgery OR near graft site
2. Consent – must be recorded
Potential risks
- Intravascular Injection
- Local Anaesthetic Toxicity
- Nerve Damage (Temp/Perm)
- Infection
- Block Failure – (DON’T repeat)
- Allergy
- Injury due to leg weakness/numbness
3. Kit
You and your helper will need your recommended PPE + sterile gloves
- Ultrasound
- Chlorhexadine 0.5% – (2% Chlorhexidine is neuro toxic)
- Tegaderm – (large)
- Aqua Gel – (sterile)
- Nerve Block Needle
- Drawing up needle
- 20ml Syringe x2
4. Anaesthetic [Anaesthesia UK]
- Drug: Levobupivicaine 0.25% (2.5mg/ml)
- MAX Dose: 2 mg/kg
- MAX Volume: 0.8 ml/kg
- Recommended Volumes (Adults):
- 30-50kg – 30ml
- >50kg – 40ml
5. STOP before you BLOCK!!!
- Correct patient?
- Correct leg?
6. Ultrasound Guided FIB
- Hold probe lateral – under the inguinal ligament
- Identify the structures – esp. the fascia planes and artery
- Needle is inserted – just under the Fascia Iliaca and above the Iliacus muscle
- Aspirate prior to injection – if there is blood reposition and recheck prior to injection
- While injecting – Stop if there is high resistance
7. Monitoring
Peak Absorption/Effect: 15-30min
- Observable Cubical
- Cardiac Monitor
- Obs: 5, 10, 15, 30 min
8. Local Anaesthetic Toxicity – here
9. Unable to Block?
Our aim within the ED is to offer a Block to ALL NoF patients. However in some cases such as Anticoagulated patients there is a relative contraindication to performing a Block and the ED senior may decide that we are unable to perform this within the ED. In these cases:
If you have a #NoF patient who you feel we wont be able to offer a Never Block in ED (please escalate to)
- Monday to Friday 0900-1700 please call theatre 5 and ask for the consultant anaesthetist of the day. (they are often doubled up)
- Weekend and OOH call the CEPOD anaesthetist. -LIMITED USEFULLNESS
- Unfortunately this is a junior who probably cant do blocks themselves
- However if their consultant is in they might be able to help , (but not all of them can do block)
You should receive a decision from anaesthetics promptly <30min as to weather this will be possible
