how are you doing your fascia iliaca blocks?

[GaseousClay]

do you place the probe cephalad/caudad and approach inplane with the needle towards the head? Or do you approach lateral to medial like a femoral nerve block but go more lateral and just inject under the fascia iliaca? I don't think there is much difference either way just curious as to what you guys do.

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[B-Bone]

do you place the probe cephalad/caudad and approach inplane with the needle towards the head? Or do you approach lateral to medial like a femoral nerve block but go more lateral and just inject under the fascia iliaca? I don't think there is much difference either way just curious as to what you guys do.

This

 

[Planktonmd]

Blind... no ultrasound

 

[Noyac]

You guys use US for this block? Really?

 

[Consigliere]

Sure. You can bill for u/s placement and make more $$$.

Oh yeah.....it's "safer" too. 😉

 

[Urzuz]

do you place the probe cephalad/caudad and approach inplane with the needle towards the head? Or do you approach lateral to medial like a femoral nerve block but go more lateral and just inject under the fascia iliaca? I don't think there is much difference either way just curious as to what you guys do.

Cephalad/caudad

You guys use US for this block? Really?

Yes, and this plays into the reason why I use the ultrasound in a cephalad/caudad orientation. You would be surprised at how the local anesthetic can often times dissect in a caudal direction (ie: AWAY from the nerves of the lumbar plexus) when you begin injected. Using an ultrasound in a cephalad/caudad plane can help you reorient your needle to achieve cephalad spread of the local anesthetic. Not sure if this has actually been studied, but it makes sense anatomically.

 

[Noyac]

Oh yeah.....it's "safer" too. 😉

BULLSH*T!!!!
But maybe in your hands.

 

[Noyac]

Yes, and this plays into the reason why I use the ultrasound in a cephalad/caudad orientation. You would be surprised at how the local anesthetic can often times dissect in a caudal direction (ie: AWAY from the nerves of the lumbar plexus) when you begin injected. Using an ultrasound in a cephalad/caudad plane can help you reorient your needle to achieve cephalad spread of the local anesthetic. Not sure if this has actually been studied, but it makes sense anatomically.

Umh, its called distal pressure.

 

[Consigliere]

BULLSH*T!!!!
But maybe in your hands.

Note the fact that safer is in quotes thereby indicating that I think it's BS as well. Additionally, the winking emoticon guy was meant to convey bull****tery as well. I've done them both ways and, again, I do them with u/s to make a few more bucks.

 

[Hoya11]

how do you do them without US? "feel the pop"? im serious im from the age of all US. only lumbar plexus blocks i do without US obviously. and why is anyone actually doing fascia iliaca blocks? for hips? they usually dont require any blocks - but maybe its for the billing purposes

 

[Urzuz]

Umh, its called distal pressure.

Umh, distal pressure has questionable efficacy at best in every study that has ever been done using it. Maybe if you used an ultrasound you would see how useless it is? You will get cephalad spread sometimes, caudal spread others.

http://bja.oxfordjournals.org/content/75/6/702.full.pdf

http://www.ncbi.nlm.nih.gov/pubmed/8694320

http://www.ncbi.nlm.nih.gov/pubmed/10338173

 

[Planktonmd]

Umh, distal pressure has questionable efficacy at best in every study that has ever been done using it. Maybe if you used an ultrasound you would see how useless it is? You will get cephalad spread sometimes, caudal spread others.

http://bja.oxfordjournals.org/content/75/6/702.full.pdf

http://www.ncbi.nlm.nih.gov/pubmed/8694320

http://www.ncbi.nlm.nih.gov/pubmed/10338173

I can tell you from experience that blind fascia Iliaca blocks do work with or without distal pressure, but you have to know how to feel the pops of the 2 fascias while advancing the needle. If you don't know how or you just can't do it then you should use ultrasound all the time.
If the cephalad spread does not happen you still get a femoral nerve block, which is very effective for both knee and hip surgeries.
This is a simple and very quick block helpful pre-op on a broken hip to facilitate positioning or as a rescue block post op, it literally takes one second to perform and requires nothing but a syringe and a blunt needle.

 

[Urzuz]

I can tell you from experience that blind fascia Iliaca blocks do work with or without distal pressure, but you have to know how to feel the pops of the 2 fascias while advancing the needle. If you don't know how or you just can't do it then you should use ultrasound all the time.
If the cephalad spread does not happen you still get a femoral nerve block, which is very effective for both knee and hip surgeries.
This is a simple and very quick block helpful pre-op on a broken hip to facilitate positioning or as a rescue block post op, it literally takes one second to perform and requires nothing but a syringe and a blunt needle.

I believe it. As I indicated in my first post, I don't know if it has ever been studied, but I try to get cephalad spread since it makes sense anatomically. I just don't appreciate snarky comments (eg: "Umh, its called distal pressure.") that attempt to make me sound like an idiot, especially when what they are talking about has been called into question time and time again.

 

[GaseousClay]

My buddy at ucsd did 3 fascia Iliaca blocks under ultrasound at ucsd with fresh cadavers with and without distal tourniquets and there was no difference. One of the ones with the best cephalad spread was with no tourniquet. Go figure

 

[dhb]

Can you put your needle blindly in a virtual space formed by 2 fascia planes? maybe more power to you, i like to do it with US guidance

 

[Noyac]

Easy everyone. Snarky comments? Check your feelings at the door.
I have been doing this a long time now. I am the go to person for difficult blocks and cases at every facility I have ever worked at. I am telling you that you can do these blocks without US. But I totally understand that training these days is completely different. I was trained without US. I have done every block I do with US and I find it to only slow me down. But I know that many of you here can't even do a FNB with it. That's fine. It's just a different way of doing things.
As far as fascia iliaca blocks go, I only do a couple a year these days. Just not all that many reasons to do them.

 

[Urzuz]

Easy everyone. Snarky comments? Check your feelings at the door.
I have been doing this a long time now. I am the go to person for difficult blocks and cases at every facility I have ever worked at. I am telling you that you can do these blocks without US. But I totally understand that training these days is completely different. I was trained without US. I have done every block I do with US and I find it to only slow me down. But I know that many of you here can't even do a FNB with it. That's fine. It's just a different way of doing things.
As far as fascia iliaca blocks go, I only do a couple a year these days. Just not all that many reasons to do them.

My feelings are intact, thanks. But rather than posting something in a civil way (eg: "I use distal presssure"), you chose to post it in a douchey way, so I called it for what it was. No hard feelings.

I don't doubt that you're great at blocks, you can do them without ultrasound, and you know what you're talking about. But as I said, I don't know if it's been studied, but it just makes anatomic sense to make sure the local dissects in a cephalad direction. Therefore, I use an ultrasound when I do fascia iliaca blocks with the probe in a caudad/cephalad orientation.

 

[Noyac]

And how many times are you doing these blocks?

****, your are the epitome of the public's opinion of a doctor. "I know what I'm doing and I do it better than anyone and nobody can tell me there is a different way." Get a grip. All I did was tell you that there is another way. You don't have to do it that way but at least understand that there is more than one way to skin a cat.

Have a nice day, I'm done with you.

 

[Urzuz]

Wow, how did you interpret what I said to be "I know what I'm doing and I do it better than anyone and nobody can tell me there is a different way"? I even told you that I don't doubt you're great at what you do (I'm NOT being snarky or sarcastic), and I said that it hasn't been studied but it makes sense to ME to do them that way. I didn't comment on what you do on that last post, did I? I justified why I do things the way I do. Look at what I said to Plankton as well, I don't doubt that you can do them without ultrasound and you get similar results. I'm finding a hard time connecting how or why you feel like I'm insulting how you practice?

Everyone is so quick to pick fights on this anonymous internet forum. Normal, human discussions spiral into people thinking that you're insulting them, and suddenly everyone is compelled to whip their's out to compare size.

Once again, in case it isn't clear, I am sorry if you felt like I was talking about how you practice because it wasn't my intent. I simply was stating what I did. So let's just lay this to rest?

 

[Planktonmd]

Can you put your needle blindly in a virtual space formed by 2 fascia planes?

Yes!