The Facts
Not a nerve block per se but a fascial plane block
Large volume of dilute anesthetic into a fascial layer
Blocking 3 nerves with 1 injection
Femoral
Lateral femoral cutaneous
Obturator (sometimes)
Anesthetic diffuses across fascial layer and blocks nerves traveling within the space
Provides anesthesia to hip and part of lower leg (femoral nerve distribution)
The Supplies
Needle: 22 G blunt-tip nerve block needle or 22 G spinal needle
Anesthetic: 30 cc of dilute, long-lasting anesthetic (i.e. 0.25% bupivicaine)
In case of systemic toxicity, have access to intralipid
Miscellaneous supplies:
Sterile probe cover
Sterile gloves
Chlorhexidine or alcohol swabs
Insulin syringe (for skin wheal)
30 cc syringe
IV tubing
The Technique
Start by finding the femoral neurovascular bundle in the short axis plane on ultrasound (the “central line” view) and then slide laterally to identify the fascia lata and fascia iliaca planes
Insert needle several centimeters lateral to neurovascular bundle directed medially
Physician performing procedure keeps one hand on probe and one hand on needle tip
Connect syringe to needle via IV tubing and have a “helper” hold syringe and push anesthetic when directed
Look for buildup of fluid in fascial layer - if it starts to accumulate intramuscularly you need to adjust your needle
- Jessica Patterson, MD and Alexei Adan, MD
Published 12/10/2018