Fascia iliaca quad weakness

[GaseousClay]

Are you guys really doing these blocks for hip scopes? Do you guys get Any pacu delays or unwanted admissions for same day surgery? I feel like there is enough femoral nerve spread that bearing weight is an issue and have had some pts be admitted which ticks surgeon off. I used 30 of 0.25% Bupi

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[Urzuz]

We don't do fascia iliaca blocks for hip scopes unless the patient is in intractable amounts of pain in the PACU. I was just talking to one of our most active orthopods about this the other day...hip scopes are one of those weird procedures where some patients cruise through it with minimal postoperative pain, whereas others are in dire straits.

For THAs, ORIFs in little old ladies, and for the hip scopes that I do end up blocking, I usually use 30 mL of 0.2% ropivacaine. The lower concentration used and ropivacaine having slightly more motor nerve sparing versus bupivacaine lead to patients being able to ambulate day of surgery (obviously with assistance).

Also, out of curiosity, how are you doing your fascia iliaca blocks?

 

[GaseousClay]

We don't do fascia iliaca blocks for hip scopes unless the patient is in intractable amounts of pain in the PACU. I was just talking to one of our most active orthopods about this the other day...hip scopes are one of those weird procedures where some patients cruise through it with minimal postoperative pain, whereas others are in dire straits.

For THAs, ORIFs in little old ladies, and for the hip scopes that I do end up blocking, I usually use 30 mL of 0.2% ropivacaine. The lower concentration used and ropivacaine having slightly more motor nerve sparing versus bupivacaine lead to patients being able to ambulate day of surgery (obviously with assistance).

Also, out of curiosity, how are you doing your fascia iliaca blocks?

I basically go lateral to the femoral nerve right under fascia iliaca. In plane technique lateral to medial

 

[Planktonmd]

A fascia iliaca block is basically a femoral nerve block, and if you have a patient where a femoral block with quad weakness is not desirable then don't do a fascia iliaca block.

 

[GaseousClay]

A fascia iliaca block is basically a femoral nerve block, and if you have a patient where a femoral block with quad weakness is not desirable then don't do a fascia iliaca block.

I hear ya plank and prob will not do these for hip scopes again, not worth it really. Just seems like a decent amt of people here are doing them for the scopes and wondering how these people are getting out of pacu without being able to walk.

 

[Planktonmd]

I hear ya plank and prob will not do these for hip scopes again, not worth it really. Just seems like a decent amt of people here are doing them for the scopes and wondering how these people are getting out of pacu without being able to walk.

You can instruct them not to put weight on the affected side for 24 hours and to use crutches

 

[pjl]

Crutches.

I use it solely as a rescue block for hip scopes when patients look like they are going to need to stay inpatient for pain control.
Taking away whatever the %pain they take after a hip scope almost always allows the patient to leave. I consent every one of them for this preop. They are pretty crappy as a block before the surgery since there still is a lot of unaddressed pain, but postop letting the patient feel bad pain and taking a bunch of it away seems to make them happy. Still, most don't need it. I would guess I am about 90+% successful at avoiding the pain control admission (only recall failing once), but admittedly I have a fairly motivated sports med type practice for hip scopes, most of which seem to have run a marathon on their messed up hips before surgery.

 

[Oggg]

Quad weakness is not an indication for admission. That said, if you are seeing too much quad weakness, maybe you are too close to the femoral nerve (try the suprainguinal approach) and try more volume lower concentration. Go down to 0.1% bupiv or 0.1% ropiv even.