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Ultrasound‐guided supra‐inguinal fascia iliaca block: a cadaveric evaluation of a novel approach
Author(s) -
Hebbard P.,
Ivanusic J.,
Sha S.
Publication year - 2011
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2011.06628.x
Subject(s) - medicine , inguinal ligament , cadaver , cadaveric spasm , iliac fossa , anterior superior iliac spine , femoral nerve , anatomy , obturator nerve , nerve block , groin , popliteal fossa , ultrasound , fascia , surgery , radiology
Summary Existing descriptions of ultrasound‐guided fascia iliaca block focus on injection of local anaesthetic inferior to the inguinal ligament, relying on supra‐inguinal spread to block the lateral femoral cutaneous nerve in the iliac fossa. In this study, we explored injectate spread and nerve involvement in a cadaveric dye‐injection model, using a supra‐inguinal ultrasound‐guided technique that places local anaesthetic directly into the iliac fossa. Bilateral injections of 20 ml 0.25% aniline blue dye were made in six unembalmed cadavers. The femoral nerve was stained by the dye in all twelve injections. The lateral femoral cutaneous nerve was stained bilaterally in five cadavers, but the nerve was absent on both sides in the sixth cadaver. The ilio‐inguinal nerve passed into the iliac fossa over the iliacus muscle in eight of the hemi‐pelvi and was stained in seven of these occasions. We have performed more than 150 blocks in patients using this approach without complications. Injection using this technique in cadavers leads to extensive fluid spread throughout the iliac fossa. In patients this approach may allow a lower volume block of the femoral nerve and lateral femoral cutaneous nerve while still injecting at a distance from the femoral nerve.