![]() The benefits in dealing with thigh bone pain are also just as evident with fractures. What might be less obvious is that knee operations may also be associated with less pain if you deploy one of these, even though you’d think the sciatic would have a bit to say there. For anaesthetic purposes, any operations where the femur itself is going to be messed with, or the hip operations where you can add to that the distribution of the lateral cutaneous nerve of the thigh. When wouldn’t you really? Any time you might consider a femoral nerve block it’s worth considering the fascia iliaca block. So here’s the quick review that will hopefully inspire you to break out a needle to sort that pain… So why isn’t everyone using it every chance they get? Well I don’t know that but I know that it should be an easy to trick to pull out of the hat where the rabbit shacks up. They also tended to have less motor deficit than the ‘find that femoral nerve technique’. They had very good results for femoral nerve territory sensory blockade, but also obturator and lateral femoral cutaneous nerve areas. More pleasingly for them I bet was that real world people responded to their plan just like the real world cadavers said they would. The spread for the 3-in-1 is at the top, and the fascia iliaca is at the bottom. They used 0.7 mL/kg in kids under 20 kg then somewhere in the region of 0.5 mL/kg of their local anaesthetic solution (they actually mixed some 1% lignocaine and 0.5% bupivacaine). The team went on to study their block in 120 patients. As it turns out the genitofemoral nerve also spends a bit of time in the area though you rarely seem to see that mentioned in modern chat. The femoral, lateral cutaneous, genitofemoral and obturator nerves all run for at least a bit behind the fascia iliaca. So they went back to the anatomy and defined the space. Honestly why do 3 year olds make you do all the work? Ultrasounds are deployed more often by echolocating dolphins than medical types…) Kids struggle to describe paraesthesia accurately enough so the technique was tough. Plus, at that stage, they were relying on paraesthesia to figure out where to put the magic mix. Although the aim was to produce block of the femoral nerve, lateral cutaneous nerve of the thigh and the obturator nerve, they weren’t happy with the bang for buck. Keen enough to work away at making the 3-in-1 block described by Winnie work. This crew were keen on local anaesthesia applied to peripheral nerves. This technique was a new variant on an old trick – put a needle in once near the groin and block three nerves. Luckily for clinicians, Dalens was writing up a technique. Well not just Dalens but Vannueville and Tanguy as well. To eat, not to wear or anything weird.Īround that same time when I was trying to figure out better solutions for what the Venus de Milo’s arms might be doing Bernard Dalens, a gent who may or may not have eaten a few snails in his lifetime, was doing some writing. It’s because I got to visit France for a bit and tried out snails for the first time. This is not because I made a point of memorising things that happened that year just in case future people invented a widespread knowledge and communication window system for recounting such stories. If you weren’t alive yet, please show the old people grappling with their constant feeling of existential angst some space. What were you doing in 1989? Wait, obviously only answer that if you were alive in 1989. Which brings us to the hero of this story – the fascia iliaca block. There are plenty of clinical situations where the nerve block should really be undertaken in the emergency department. And that’s not just a phenomenon for the operating theatre. It might be this or it might be an issue of timing and culture that probably inhibit people from getting on with a good block. Chief amongst these would be the risk of injury to nerve and the risk of injury to everyone involved (obviously mostly the patient but also staff) if the patient develops central nervous or cardiovascular toxicity. ![]() They do, sometimes, have a dark side associated with them too. Plus even when you know how they work, local anaesthetics are pretty impressive in action. A better quality of analgesia is likely to be on offer. Less use of other strong analgesics is certainly one of those benefits. The advantages of regional techniques, or for today’s post peripheral nerve blockade are pretty numerous. Golden sense of superiority in your dealings with that foul gorgon known as pain. Dr Andrew Weatherall with a little bit about a super easy and super useful option – the fascia iliaca block.Īt a time when opioids are slowly letting the happy veil slip we might be just about to usher in a golden age of blocks. So far there’s not a lot on regional techniques or nerve blocks lurking around the site. ![]()
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