Comparison of the Fascia Iliaca Compartment Block with the 3-in-1 Block in Children

Lumbar plexus block: an anatomical study

“…between the psoas and quadratus lumborum muscles, (which contain part of the lumbar plexus as it emerges from the lateral side of psoas major) or into the posterior part of the psoas muscle at this level [5-71; (d) anterior approaches where the needle is placed lateral to the femoral artery in the inguinal region (inguinal paravascular technique [8]) or immediately behind the fascia iliaca at a point two-thirds laterally along the inguinal ligament [9].…”

“…It has been assumed that the depth of the lumbar plexus and the distance between its roots make it difficult to locate, necessitating multiple procedures and resulting in a high failure rate [1,2]. Despite these difficulties a variety of techniques for lumbar plexus blockade have been described for use in the management of chronic pain, and in the provision of surgical analgesia for adults and children [3].Both posterior and anterior approaches to the plexus have been described: (a) paravertebral approaches using either multiple injections at each root of the plexus Although it has been used for many years, it has never been published, and no previous anatomical studies have been undertaken.between the psoas and quadratus lumborum muscles, (which contain part of the lumbar plexus as it emerges from the lateral side of psoas major) or into the posterior part of the psoas muscle at this level [5-71; (d) anterior approaches where the needle is placed lateral to the femoral artery in the inguinal region (inguinal paravascular technique [8]) or immediately behind the fascia iliaca at a point two-thirds laterally along the inguinal ligament [9].In recent assessments of the extent of sensory and motor blockade achieved with different approaches to the lumbar plexus, the posterior approaches were found to result in a more extensive block than were the anterior approaches [5,9]. Although the posterior approaches are likely to result in superior lumbar plexus anaesthesia, they may be technically more difficult and may be associated with inadvertent extradural or subarachnoid block, particularly if large volumes of local anaesthetic are used [5,10].…”

A review of approaches and techniques for lower extremity nerve blocks

“…18,19 A recent study has also reported better blockade of all three nerves with echoguidance. 11 In 1988, to improve obturator nerve block seen with the 3-in-1 technique, Dalens et al 20 introduced the fascia iliaca compartment block, a method by which LA was injected immediately posterior to the fascia iliaca while firm compression was applied distal to the puncture site. In 120 children randomized to a (neurostimulation-guided) 3-in-1 or a (loss of resistance-guided) fascia iliaca compartment block, these authors reported a similar rate of complete sensory block for the femoral nerve (100%); however the fascia iliaca block resulted in improved blockade of the lateral femoral cutaneous and obturator nerves (92 vs 15% and 88 vs 13% of patients respectively; both P < 0.05).…”

“…In 120 children randomized to a (neurostimulation-guided) 3-in-1 or a (loss of resistance-guided) fascia iliaca compartment block, these authors reported a similar rate of complete sensory block for the femoral nerve (100%); however the fascia iliaca block resulted in improved blockade of the lateral femoral cutaneous and obturator nerves (92 vs 15% and 88 vs 13% of patients respectively; both P < 0.05). 20 The same comparison was carried out in 100 adults. Again, despite a similar rate of femoral block (88-90%), the lateral femoral cutaneous nerve was more frequently anesthetized with the fascia iliaca compartment technique (90 vs 62%; P < 0.05).…”

“…1 Although sensible and anatomically sound, this contention has not been confirmed with RCTs. Loss of resistance, elicitation of paresthesiae, neurostimulation and ultrasonography have all been investigated as adjunctive modalities for nerve localization in 3-in-1 block: 7,11,[18][19][20][21][22] although the results of these studies can be extrapolated to femoral blockade, further RCTs are nonetheless required to investigate their use in the context of a specific femoral nerve block technique. Finally, as evidenced by the confusion in terminology, the difference between 3-in-1 and femoral nerve block requires elucidation.…”