Fascia iliaca blocks (FIC, FICB) is a

local anesthetic nerve block Nerve block or regional nerve blockade is any deliberate interruption of signals traveling along a nerve, often for the purpose of pain relief. Local anesthetic nerve block (sometimes referred to as simply "nerve block") is a short-term block, ...

, a type of

regional anesthesia Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, i.e. local insensitivity to pain, although other local senses may be affected as well. It all ...

technique, used to provide analgesia or anaesthesia to the

hip In vertebrate anatomy, the hip, or coxaLatin ''coxa'' was used by Celsus in the sense "hip", but by Pliny the Elder in the sense "hip bone" (Diab, p 77) (: ''coxae'') in medical terminology, refers to either an anatomical region or a joint on t ...

and

thigh In anatomy, the thigh is the area between the hip (pelvis) and the knee. Anatomically, it is part of the lower limb. The single bone in the thigh is called the femur. This bone is very thick and strong (due to the high proportion of bone tissu ...

. FICB can performed by using

ultrasound Ultrasound is sound with frequency, frequencies greater than 20 Hertz, kilohertz. This frequency is the approximate upper audible hearing range, limit of human hearing in healthy young adults. The physical principles of acoustic waves apply ...

or with a loss of resistance technique, the latter sometimes referred to as the "''two-pop-method''". FICB works by affecting the femoral, obturator and the lateral cutaneous nerves with a

local anesthetic A local anesthetic (LA) is a medication that causes absence of all sensation (including pain) in a specific body part without loss of consciousness, providing local anesthesia, as opposed to a general anesthetic, which eliminates all sensati ...

Technique

When FICB is performed with the loss of resistance technique, the injection site for FICB is found by drawing an imaginary line between the

pubic tubercle The pubic tubercle is a prominent tubercle on the superior ramus of the pubis bone of the pelvis. Structure The pubic tubercle is a prominent forward-projecting tubercle on the upper border of the medial portion of the superior ramus of th ...

to the

anterior superior iliac spine The anterior superior iliac spine (ASIS) is a bony projection of the iliac bone, and an important landmark of surface anatomy. It refers to the anterior extremity of the iliac crest of the pelvis. It provides attachment for the inguinal ligament, ...

. The injection site is 1 cm. below the

lateral Lateral is a geometric term of location which may also refer to: Biology and healthcare * Lateral (anatomy), a term of location meaning "towards the side" * Lateral cricoarytenoid muscle, an intrinsic muscle of the larynx * Lateral release ( ...

one third and the

medial Medial may refer to: Mathematics * Medial magma, a mathematical identity in algebra Geometry * Medial axis, in geometry the set of all points having more than one closest point on an object's boundary * Medial graph, another graph that repr ...

two thirds of this line. Two losses of resistances are felt as the

fascia lata The fascia lata is the deep fascia of the thigh. It encloses the thigh muscles and forms the outer limit of the fascial compartments of thigh, which are internally separated by the medial intermuscular septum and the lateral intermuscular sept ...

and the fascia iliaca is penetrated by a semi-blunt

cannula A cannula (; Latin meaning 'little reed'; : cannulae or cannulas) is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of samples. In simple terms, a cannula can surround the inner or out ...

. Aspiration (drawing back the cannula) is performed, after which a

local anaesthetic A local anesthetic (LA) is a medication that causes absence of all sense, sensation (including pain) in a specific body part without loss of consciousness, providing local anesthesia, as opposed to a general anesthetic, which eliminates all sen ...

is injected while compressing on the skin

distal Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position provi ...

ly to increase

cranial Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek language, Greek roots, describe something in its standard anatomical position. Thi ...

distribution. FICB can generally be performed with minimally required training and by non-medical practitioners

Medical uses

FIC can be used to offer pain relief for

hip fractures A hip fracture is a break that occurs in the upper part of the femur (thigh bone), at the femoral neck or (rarely) the femoral head. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually th ...

in adults and femoral fractures in children.

Adverse effects

FIC is generally safe to use and have few

adverse effects An adverse effect is an undesired harmful effect resulting from a medication or other intervention, such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. The term complic ...

. There is a 0.09-3.2% risk of

hematomas A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries. A hematoma is ...

at the injection site and a 0.18% risk of local anaesthetic intoxication. There are also case reports of pneumoretroperitoneum using continuous infusion, bladder puncture with a modified block under very special conditions and postoperative neuropathy.

History

The block was first described in 1989 as an alternative to 3-in-1 nerve block in children.

References

{{Dosage forms Regional anesthesia

Technique

Medical uses

Adverse effects

History

See also

References