Fascia Iliaca Compartmental Block
The fascia iliaca compartmental block is a varied approach to the lumbar plexus block. A large volume of local anesthetic is injected deep to the fascia iliacus about one third of the way between the anterior superior iliac spine and the pubic symphysis. This anatomical plane deep to the fascia iliacus contains at different points the femoral, lateral femoral cutaneous and obturator nerves. These nerves arise from the lumbar plexus T12-L5 and provide most of the innervation to the hip and proximal femur (image 1).
The panis should be taped out of the way if necessary. The ultrasound probe should be placed perpendicular to the floor over the anterior superior iliac spine (image 2 and image 5). The probe is then rotated approximately 20 degrees as it is slid medially 1/3rd of the distance to the pubic symphysis (image 3). Care should be taken to stay lateral to the iliac artery. Scan to identify the "bow tie" structure which consists of the sartorius muscle, internal oblique muscle, fascia lata, fascia iliaca and iliacus muscle. PNBschool recommends an in plane approach with the needle inserted inferiorly to the ultrasound probe (image 3). Two "pops" will be felt as the needle passes through the fascia lata and the fascia iliaca. The needle should be advanced just beneath the fascia iliacus and 30-40ml of local anesthetic should be injected. Cephalad spread of local anesthetic should be observed. The block needle should be visualized at all times to assure the abdominal cavity is not punctured.
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