Fascia iliaca blocks THA Do they work?

[deleted126335]

Been doing ultrasound regional for 18 months now. Not sold on this block for THA. not sure that it adds anything to spinal plus 100-150 ug Morphine.

50ml 0.35% ropivicaine.

Comments?

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[dhb]

Been doing ultrasound regional for 18 months now. Not sold on this block for THA. not sure that it adds anything to spinal plus 100-150 ug Morphine.

50ml 0.35% ropivicaine.

Comments?

I don't think it's great for THA it is effective for procedures not involving the acetabulum: nails etc...

 

[sevoflurane]

I don't think it's great for THA it is effective for procedures not involving the acetabulum: nails etc...

Yep. Look up the osteotomes of the acetabubulum/hip. It is dually innervated (acetabulum). It's a good figure to look at with regards to osteotomal anatomy. FIB will get about 1/3 if placed correctly. My needle entry point is not perpendicular to the floor/patient. I actually point my needle slightly cephalad to get more proximal spread towards the hip joint.
FIB reliably covers the lateral femoral cuatneous nerve, which is usually the incisional site.

If you have a spinal and IT duramorph on board, it may not add that much. Great for Hip cases where patients aren't able to roll over or sit for a spinal.

Way to go Doze. Glad you are getting comfortable with USD.

 

[deleted126335]

Yep. Look up the osteotomes of the acetabubulum/hip. It is dually innervated (acetabulum). It's a good figure to look at with regards to osteotomal anatomy. FIB will get about 1/3 if placed correctly. My needle entry point is not perpendicular to the floor/patient. I actually point my needle slightly cephalad to get more proximal spread towards the hip joint.
FIB reliably covers the lateral femoral cuatneous nerve, which is usually the incisional site.

If you have a spinal and IT duramorph on board, it may not add that much. Great for Hip cases where patients aren't able to roll over or sit for a spinal.

Way to go Doze. Glad you are getting comfortable with USD.

Thanks. Some (almost) old dogs are still trainable.

 

[Oggg]

Limited experience but I agree with all of the above. Good for nails and hemi hips, and better than nothing for THA when SAB is contraindicated or refused.

 

[BLADEMDA]

LUmbar Plexus is significantly better than FIB for total hip replacemets. That said, it is better than nothing.

 

[reanimatore]

Been doing ultrasound regional for 18 months now. Not sold on this block for THA. not sure that it adds anything to spinal plus 100-150 ug Morphine.

50ml 0.35% ropivicaine.

Comments?

I think you're right in that a SAB with IT morphine provides pretty solid analgesia for THAs for the first 24 hours or so.

However, I think it's a nice block to have in your back pocket when neuraxial block is contraindicated.

I actually prefer the FI block to lumbar plexus. For me it's faster and it seems to work just as well. Lumbar plexus blocks also pose more significant potential complications than other peripheral blocks given the close proximity to the neuraxis and retroperitoneum.

 

[Oggg]

Yeah. National shortage of duramorph makes FICB more important.