Ultrasound Guided Fascia Iliaca Compartment Block (FICB)

 

 Maine Medical Center Ultrasound guided Fascia Iliaca Block Guideline

Maine Medical Center Ultrasound guided Fascia Iliaca Block Guideline

Who is a good candidate for a FICB?

  • Patients with a hip fracture
  • NO Neurologic deficit
  • NO multisystem trauma
  • NO allergies to local anesthetic

Why do a FICB?

  • Decreases pain, delirium, need for opiates, hypoxic events
  • Ideal for elderly patients with poor tolerance to opiates

What are the risks of a FICB?

  • Pain at injection site
  • Nerve palsy
  • Intravascular injection
  • Local anesthetic systemic toxicity (LAST)

What equipment is needed?

Procedure Details

  • Document distal neurovascular exam
  • Consult orthopedic surgery (do not need to wait for to await callback before performing block)
  • Obtain patient consent
  • Position patient and ultrasound machine
  • Order bupivicaine (dose dependent)
    • Max 2 mg/kg
    • E.g. 100 mg safe for 50 kg patient
  • Standard ASA monitoring (telemetry during procedure with continuous pulse oximetry, BP measurement and IV access)
  • Perform FICB
  • Inform patient on block characteristics
    • Onset approximately 20 minutes
    • Duration approximately 8-12 hours
FICB anatomy.jpg
 
fascial planes.jpg
 
 

Ultrasound anatomy for right sided FICB

 

Local Anesthetic Toxicity Syndrome

  • Rare complication from FICB
  • Occurs only with intravascular injection (risk is lessened with ultrasound guided approach)
  • Signs include arrhythmias, seizures, convulsions
  • Treatment
    • Supportive and standard care
    • Consider Lipid Emulsion therapy in cardiovascular collapse (found in Pyxis MedStation) (1.5 ml/kg bolus then infusion)

 

 

Written by Peter Croft, MD

Edited and Posted by Jeff Holmes, MD


References

1)  Mouzopoulos, G., Vasiliadis, G., et al. Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study. Journal of Orthopaedics and Traumatology. June 2009

2) Foss, N., Kristensen, B., et al. Fascia Iliaca Compartment Blockade for Acute Pain Control in Hip Fracture Patients. A Randomized, Placebo-Controlled Trial. Anesthesiology 2007

3) Monzon, D., Vazquez, J., et al. Pain treatment in post-traumatic hip fracture in the elderly: regional block vs. systemic non-steroidal analgesics. International Journal of Emergency Medicine. Sept 2010

4) Capdevila, X., Biboulet, P., et al. Comparison of the Three-in-One and Fascia Iliaca Compartment Blocks in Adults: Clinical and Radiographic Analysis. Anesthesia and Analgesia 1998.