Fascia iliaca blocks (FIC, FICB) is a

local anesthetic nerve block Local anesthetic nerve block (local anesthetic regional nerve blockade, or often simply nerve block) is a short-term nerve block involving the injection (medicine), injection of local anesthetic as close to the nerve as possible for analgesia, pai ...

, 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, that is, local insensitivity to pain, although other local senses may be affected as well. It ...

technique, used to provide analgesia or anaesthesia to the

hip In vertebrate anatomy, hip (or "coxa"Latin ''coxa'' was used by Celsus in the sense "hip", but by Pliny the Elder in the sense "hip bone" (Diab, p 77) in medical terminology) refers to either an anatomical region or a joint. The hip region is ...

and

thigh In human 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 ...

. FICB can performed by using

ultrasound Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...

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 pain sensation. In the context of surgery, a local anesthetic creates an absence of pain in a specific location of the body without a loss of consciousness, as opposed to a general an ...

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 (abbreviated: 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 ingui ...

. The injection site is 1 cm. below the

lateral Lateral is a geometric term of location which may refer to: Healthcare *Lateral (anatomy), an anatomical direction *Lateral cricoarytenoid muscle *Lateral release (surgery), a surgical procedure on the side of a kneecap Phonetics *Lateral cons ...

one third and the medial 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 septu ...

and the

fascia iliaca The iliac fascia, or Abernethy's fascia, is a fascia in the region of the ilium of the pelvis. It has the following connections: * ''laterally'', to the whole length of the inner lip of the iliac crest. * ''medially'', to the linea terminalis of ...

is penetrated by a semi-blunt

cannula A cannula (; Latin meaning 'little reed'; plural or ) 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 outer surfaces ...

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

local anaesthetic A local anesthetic (LA) is a medication that causes absence of pain sensation. In the context of surgery, a local anesthetic creates an absence of pain in a specific location of the body without a loss of consciousness, as opposed to a general an ...

is injected while compressing on the skin

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

ly to increase

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

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). Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually the person cannot walk. They most often occur as a res ...

in adults and

femoral fractures A femoral fracture is a bone fracture that involves the femur. They are typically sustained in high-impact trauma, such as car crashes, due to the large amount of force needed to break the bone. Fractures of the diaphysis, or middle of the femur ...

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 complica ...

. 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 b ...

at the injection site and a 0.18% risk of

local anaesthetic intoxication A local anesthetic (LA) is a medication that causes absence of pain sensation. In the context of surgery, a local anesthetic creates an absence of pain in a specific location of the body without a loss of consciousness, as opposed to a general an ...

. There are also case reports of

pneumoretroperitoneum Pneumoretroperitoneum is the presence of air in the retroperitoneum. It is always a pathological condition and can be caused by a perforation of a retroperitoneal hollow organ such as the duodenum, colon or rectum. Pneumoretroperitoneum can best b ...

using continuous infusion,

bladder puncture The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...

with a modified block under very special conditions and

postoperative neuropathy Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

History

The block was first described in 1989 as an alternative to

3-in-1 nerve block 3-in-One Oil is a general-purpose lubricating oil sold for household and do-it-yourself use. It was originally formulated in 1894 for use on bicycles, and remains a popular lubricant for their chains. Its name, given by inventor George W. Cole o ...

in children.

References

{{Dosage forms Regional anesthesia

Technique

Medical uses

Adverse effects

History

See also

References