Fascia iliaca block for neck of femur fracture in the Emergency Dept.

Modified femoral/’3-in-1’block which is more reliable in reaching lumbar plexus targets.
Injection of local anaesthetic beneath fascia-iliaca into the compartment containing the femoral and lateral femoral cutaneous nerves+/-obturator nerve that provides sensory innervation to the neck of femur.
Surface landmark technique with use of short-bevelled needle to give two-‘pop’ feel as the needle passes through fascia-lata, then fascia-iliaca.
Injection site is distant from large femoral vessels.
Compartment block –requires adequate volume of local anaesthetic to assure adequate spread of solution into and around compartment.
Can reduce opiate analgesia requirements and associated opiate side effects (delirium, respiratory depression, sedation)
No requirement for ultrasound or nerve stimulator.
Low risk of adverse events.
Contraindications as per femoral nerve block (local anaesthetic allergy, injection site infection etc.) plus previous femoral bypass surgery.
Risks as per femoral nerve block(bleeding or haematoma formation particularly with anticoagulation; local anaesthetic toxicity/intravascular injection; direct nerve injury)although risks are theoretically lower as the injection site is distant to nerve and vascular structures.

Technique (30ml 0.25% levobupivicaine)

Clean/ sterilise skin.
Draw/ identify line between anterior superior iliac spine and pubic tubercle.
Identify point dividing lateral one-third and medial two-thirds of this line.
Point of injection 2cm-2.5cm distal to this point.
Subcutaneously infiltrate 1ml 1% lignocaine to anaesthetise injection site.
Break skin at injection site with 18G needle.
Insert short bevelled needle perpendicular to skin feeling for a slight increase, then loss of resistance, or ‘pop’ as fascia lata is penetrated.
Second ‘pop’ indicates penetration of fascia iliaca and point of infiltration.
Aspirate to ensure against intravascular injection.
Carefully infiltrate 30ml 0.25% levobupivicaine.