00:48 - Evolution of the fascia iliaca block 03:40 - Out-of-plane femoral nerve block as a preferred alternative 05:11 - Technique of the out-of-plane suprainguinal femoral nerve block 06:46 - Insertion of a catheter for continuous nerve block 07:34 - Clinical considerations in RA for hip analgesia 10:08 - Transverse IP infra-inguinal fascia iliaca block (not recommended) 10:38 - Longitudinal IP supra-inguinal fascia iliaca block 12:11 - Summary / Conclusion
OOP Femoral nerve block 10ml with needle directed cranial first and then SIFIB into the clearly visible and open fascia iliac plain is a game changer for me.
Excelent Dr. K.J.Chin, that variant is a better reference than lateral aproach to see the needle under the fascia iliaca, and spread de LA to create a path for the needle is very creative. Thanks.
Excellent presentation as always! Do you use the same technique even for obese individuals? For those patients sometimes due to the thick soft tissue you need to go through & steep angle used before reaching the desired plane it is quite difficult to adopt a shallow angle afterwards to keep the needle in the plane when you hydrodissect to the cephalad direction.
Good observations - and there may also be a pannus that needs to be retracted by an assistant. In these cases, probably the best way around it is to use a Catheter-Through-Needle (CTN) set rather than the catheter-over-needle set. If you open up the fascial plane/space with the loading bolus, the catheter should thread through the Tuohy, turn the corner despite a steep needle angle, and find its way cranially under fascia iliaca.
Yes - so do I! OOP ensures you come right down on the vessel so it doesn't slide away from the needle, and the IP view then allows you to ensure you have the right trajectory and don't pierce the back wall. Thanks for the comment!
@kijinnchin great video. Is it possible deposition of local anesthetic farther away from femoral nerve (bowtie or J Gadsden's approach) decreases incidence/intensity of motor block via differential sensory block (a la QL for abdominal surgery; or Lumbar ESP for spine surgery)? This may have useful in an outpatient setting to facilitate PT on POD0, prior to the advent of PENG; but a moot point if using fascia iliac for inpatient hip fracture (instead of ambulatory total hip arthroplasty)
Yes, I think that differential block based on distance of deposition from target nerves is a valid point. May also explain why lumbar plexus blocks were used for a long time in total hip replacements, seemingly without much concern for dense motor block. Your reasoning regarding appropriate use of blocks for a given context is also sound and in line with my thinking.
@@KiJinnChin Am curious if you feel differential block is the reason behind analgesic efficacy of high-volume (30 ml) adductor, likely due to indirect spillover to Femoral nerve). As well as quadriceps palsy risk in slender patients BMI < 25.
I have never deliberately done it. It could be effective - it may depend how lateral to the tip of the TP you are; because the lumbar plexus diverges more anteriorly the more lateral you go. So this lowers the probability of LA reaching the LP. The question to ask yourself is why you would choose it over other techniques.
Hip arthroscopy is complicated with regards to pain etiology, and unpredictable. PENG would address capsule pain, but pain may also be muscular, e.g. from traction or fluid extravasation. If immediate weight-bearing and quads function not required, femoral/FI block might cover more bases.
@@KiJinnChin Thanks for the quick reply! I do think that quad function is valuable in the outpatient setting where many hip scopes don’t involve repairs and can be quick and often not that painful.
perfect job, thank you very much (also the rest of your videos, everything very well explained and highly interesting, uptodate resources!) - question: how does the PENG block fit into this variety of approaches? esp., do you think it is possible to get the AON and the LCFN reliable into one technique (esp. interesting for continuous postop. analgesia)? Thanks in advance for a reply!
![Fascia Iliaca Block - a Definitive "How-To" Guide [2025]](/img/n.gif)
00:48 - Evolution of the fascia iliaca block
03:40 - Out-of-plane femoral nerve block as a preferred alternative
05:11 - Technique of the out-of-plane suprainguinal femoral nerve block
06:46 - Insertion of a catheter for continuous nerve block
07:34 - Clinical considerations in RA for hip analgesia
10:08 - Transverse IP infra-inguinal fascia iliaca block (not recommended)
10:38 - Longitudinal IP supra-inguinal fascia iliaca block
12:11 - Summary / Conclusion
OOP Femoral nerve block 10ml with needle directed cranial first and then SIFIB into the clearly visible and open fascia iliac plain is a game changer for me.
Do you continue to the Supra inguinal region from the same femoral puncture point or do another cranial puncture?
Excelent Dr. K.J.Chin, that variant is a better reference than lateral aproach to see the needle under the fascia iliaca, and spread de LA to create a path for the needle is very creative. Thanks.
This presentation has answered many questions in my mind, thank you professor for this excellent video.
At 6:37, is that the LFCN in the middle of the screen directly above and out of the fascial plane?
Excellent presentation as always! Do you use the same technique even for obese individuals? For those patients sometimes due to the thick soft tissue you need to go through & steep angle used before reaching the desired plane it is quite difficult to adopt a shallow angle afterwards to keep the needle in the plane when you hydrodissect to the cephalad direction.
Good observations - and there may also be a pannus that needs to be retracted by an assistant. In these cases, probably the best way around it is to use a Catheter-Through-Needle (CTN) set rather than the catheter-over-needle set. If you open up the fascial plane/space with the loading bolus, the catheter should thread through the Tuohy, turn the corner despite a steep needle angle, and find its way cranially under fascia iliaca.
@@KiJinnChin Thank you Dr Chin! Definitely will give that a try next time
Excellent explanation, diagrams, and videos. I also use this OOP-to-IP approach for PIVs and arterial lines.
Yes - so do I! OOP ensures you come right down on the vessel so it doesn't slide away from the needle, and the IP view then allows you to ensure you have the right trajectory and don't pierce the back wall. Thanks for the comment!
@kijinnchin great video. Is it possible deposition of local anesthetic farther away from femoral nerve (bowtie or J Gadsden's approach) decreases incidence/intensity of motor block via differential sensory block (a la QL for abdominal surgery; or Lumbar ESP for spine surgery)? This may have useful in an outpatient setting to facilitate PT on POD0, prior to the advent of PENG; but a moot point if using fascia iliac for inpatient hip fracture (instead of ambulatory total hip arthroplasty)
Yes, I think that differential block based on distance of deposition from target nerves is a valid point. May also explain why lumbar plexus blocks were used for a long time in total hip replacements, seemingly without much concern for dense motor block. Your reasoning regarding appropriate use of blocks for a given context is also sound and in line with my thinking.
@@KiJinnChin Am curious if you feel differential block is the reason behind analgesic efficacy of high-volume (30 ml) adductor, likely due to indirect spillover to Femoral nerve). As well as quadriceps palsy risk in slender patients BMI < 25.
Thanks for your nice work that I am a very big fan of.
Do you think QLB 3 for hip surgery analgesia can be effective ?
Thanks
I have never deliberately done it. It could be effective - it may depend how lateral to the tip of the TP you are; because the lumbar plexus diverges more anteriorly the more lateral you go. So this lowers the probability of LA reaching the LP. The question to ask yourself is why you would choose it over other techniques.
@@KiJinnChin Thanks a lot. You are right, The QLB would be with very unpredictable effect.
Excellent explaination
Great Insight .
@kijinnchin and what about these RA methods for urgent thrombectomy in femoral artery? Which one you would choose?
Very good Explained thank you for uploading this education material which helps Anesthesiologist and Patient as well
10:15 well done for speaking some sense and challenging this.
What is your go to block for hip arthroscopy at an outpatient surgery center? Would you do this block or a PENG block?
Hip arthroscopy is complicated with regards to pain etiology, and unpredictable. PENG would address capsule pain, but pain may also be muscular, e.g. from traction or fluid extravasation. If immediate weight-bearing and quads function not required, femoral/FI block might cover more bases.
@@KiJinnChin Thanks for the quick reply! I do think that quad function is valuable in the outpatient setting where many hip scopes don’t involve repairs and can be quick and often not that painful.
perfect job, thank you very much (also the rest of your videos, everything very well explained and highly interesting, uptodate resources!)
- question: how does the PENG block fit into this variety of approaches? esp., do you think it is possible to get the AON and the LCFN reliable into one technique (esp. interesting for continuous postop. analgesia)? Thanks in advance for a reply!
mmmh? still open and hot question, at least in my mind. would love to read your thoughts on it
thank you very much, professor. Very useful.