The effect of the volume of supra-inguinal injected solution on the spread of the injectate under the fascia iliaca: a preliminary study

Abstract

The fascia iliaca compartment is the compartment confined by the fascia iliaca (FI) and a muscular layer formed by the iliac-and psoas muscle. This compartment creates a virtual tunnel that contains the femoral nerve (FN), the obturator nerve (ON), and the lateral femoral cutaneous nerve (LFCN) of the lumbar plexus. In this pilot study, we aimed to determine the suggested volume needed to reach the three target nerves of the lumbar plexus (FN, ON, and LFCN) with a single-injection ultrasound-guided supra-inguinal fascia iliaca compartment (S-FICB). A computer tomography (CT scan)-guided step-up/step-down sequence was used to determine the suggested injection volume to target all three nerves. Subsequently, an anatomist blinded for the injected volume and CT findings, dissected the cadavers, and evaluated the spread of dye underneath the fascia iliaca. In total, seven pelvic areas of four cadavers were evaluated on CT scan and dissected. Distribution of dye underneath the FI in relation to the FN, ON, and the LFCN was recorded in all dissected cadavers. Combining CT and dissection findings, the suggested volume to reach the FN, ON, and LFCN with an S-FICB was 40 mL.

Ultrasound suprainguinal fascia iliaca block in knee surgery

“…We read with great interest the article from Vermeylen about suprainguinal fascia iliaca compartment block (SFICB) [1].…”

“…Ultrasound-guided FICB is a fascial block, with two possible approaches, infrainguinal or suprainguinal, aiming femorocutaneous, femoral and obturator nerves, all together in a single-shot technique [2]. Nevertheless, suprainguinal approach to FICB leads to a more consistent block of the three target nerves [1,2].…”

Fascia iliaca compartment block

“…Correct needle placement is confirmed by separation of the fascia iliaca from the iliopsoas muscle with LA spreading towards the FN medially and the iliac crest laterally. 6 Volumes of 30e40 ml, ensuring compliance with safe dose limits for the LA, are routinely used to ensure optimal spread.…”

“…A recent cadaveric study found that a volume of 40 ml was required to reliably block all three nerves using this approach. 6…”

Implementation of the Obturator Nerve Block into a Supra-Inguinal Fascia Iliaca Compartment Block Based Analgesia Protocol for Hip Arthroscopy: Retrospective Pre-Post Study

“…One of the anterior approach to the lumbar plexus block is supra-inguinal fascia iliaca compartment block (SI-FICB) [11,12]. This technique, theoretically, can block the femoral, obturator, and lateral femoral cutaneous nerves simultaneously, since these nerves are contained within the same compartment [13].…”