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Fascia Iliaca Block - FIB

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November 1, 2020

Slide show – HERE

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

  1. Observable Cubical
  2. Cardiac Monitor
  3. 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

 

Further reading