Fascia Iliaca Tips #2

December 30, 2012
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THE SPREAD

Usually, the Fascia Iliaca and Fascia Lata are clearly identifiable next to the thinner and less echogenic muscle fibers of the Sartorius and Iliopsoas muscles. There are times, however, when the deeper border of the Sartorius muscle blends in well or the exact position of the tip of your needle is difficult to identify. As there are no nerves that you are trying to stimulate as an endpoint with this nerve block, you must rely on ‘feel’, your understanding of sonoanatomy and clues that you can find in the ultrasound picture. Here are a few tips to confirm that you are injecting in the right place during your Fascia Iliaca nerve block.

I mentioned in the FASCIA ILIACA section that the local should spread in a cranial direction. It should be incredibly easy to inject and track in a thick black line without muscle stranding after initially expanding the space next to the needle tip. If the ‘bulge’ of local anesthetic spread stays localized, you are within a muscle belly. That should be an obvious observation. If, however, you see the local spread in a linear pattern, but it is heading toward the feet, you are still in the wrong place. Let me expand on what is going on here how to fix this problem. First, take a look at the cadaver picture below.

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