This approach using the probe along the inguinal ligament has many advantages: 1) The NAVL anatomy is much more clearly seen than the probe-perpendicular approach. 2) The needle is not aimed at the abdominal cavity and bowel. 3) This approach avoids the problem of excessive abdominal fat, which often makes "finding the bowtie" more difficult because the probe cannot be placed at the proper angle. And I agree, for any benefit following hip surgery, higher volumes (40-60 ml) will achieve more adequate cephalad spread. Having someone hold distal pressure during injection also helps cephalad spread.
Although it is visually pleasing to see the femoral nerve, it’s hard to see how 20-30 ml of LA with this approach will reach the lumbar plexus. I find that your target should be more cephalad so that as you inject more of the LA spreads posterior and cephalad toward the lumbar plexus. My 2 cents anyway
Pete, which specific sensory & motor functions would ortho like us documenting? Sensation to light touch in all 5 distributions of the foot? Should we document the lateral hip where the LFCN covers? More than that? or less? For motor just EHL/FHL function or quads firing? What else?
thanks for the excellent pictures - most useful
One of the best Vedic on fascia iliaca block .... 👍
This is my favorite approach to this block that I've seen.
This approach using the probe along the inguinal ligament has many advantages: 1) The NAVL anatomy is much more clearly seen than the probe-perpendicular approach. 2) The needle is not aimed at the abdominal cavity and bowel. 3) This approach avoids the problem of excessive abdominal fat, which often makes "finding the bowtie" more difficult because the probe cannot be placed at the proper angle. And I agree, for any benefit following hip surgery, higher volumes (40-60 ml) will achieve more adequate cephalad spread. Having someone hold distal pressure during injection also helps cephalad spread.
Although it is visually pleasing to see the femoral nerve, it’s hard to see how 20-30 ml of LA with this approach will reach the lumbar plexus. I find that your target should be more cephalad so that as you inject more of the LA spreads posterior and cephalad toward the lumbar plexus. My 2 cents anyway
Pete, which specific sensory & motor functions would ortho like us documenting? Sensation to light touch in all 5 distributions of the foot? Should we document the lateral hip where the LFCN covers? More than that? or less? For motor just EHL/FHL function or quads firing? What else?
Amazing
nice video...thanx sir