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Chapter 32B. Ultrasound-Guided Fascia Iliaca Block

Which of the following statements regarding the anatomy of the fascia iliaca is true?

A. The deep circumflex artery is covered by the fascia iliaca.

B. The fascia iliaca is bound superiorly to the inguinal ligament.

C. The fascia iliaca merges with the fascia overlying the psoas muscle.

D. The sartorius muscle is covered by the fascia iliaca.

C is correct. The fascia iliaca merges medially with the fascia overlying the psoas muscle.

A is incorrect. The deep circumflex artery is located superior to the fascia iliaca and as such can be an important landmark. If spread of local anesthetic is observed around the deep circumflex artery, the deposition of local anesthetic was above the fascia iliaca.

B is incorrect. The fascia iliaca covers the entire iliac muscle and attaches cranially to the iliac crest.

D is incorrect. The sartorius muscle is located superior to the iliac muscle and superior to the fascia iliaca.

Which of the following statements regarding the use of a fascia iliaca compartment block (FICB) in clinical practice is true?

A. An FICB significantly reduces morphine consumption after total hip arthroplasty.

B. An FICB significantly reduces morphine consumption in patients with a hip fracture.

C. An FICB facilitates early mobilization after lower limb surgery.

D. To avoid contractions of the adductor muscles during transurethral bladder resections, an FICB can be used.

B is correct. Numerous studies have investigated the effect of an FICB for perioperative analgesia in patients with hip fractures. Although these studies are very heterogeneous (different patient populations; different FICB techniques; different volumes, concentrations, and types of local anesthetics), the overall conclusion is that the FICB decreases analgesic requirements, pain scores, and the incidence of postoperative complications.1,2

A is incorrect. A recent study by Shariat et al could not demonstrate a beneficial effect of an FICB on postoperative pain after total hip arthroplasty. As the hip joint is innervated by both the lumbar and sacral plexus, it is clear that an FICB will not fully cover postoperative pain.3

C is incorrect. As an FICB will consistently block the femoral nerve with an associated quadriceps weakness, the FICB may impede early mobilization.

D is incorrect. All adductor muscles, except the pectineus muscle, are innervated by the obturator nerve. As the obturator nerve is not reliably blocked by an FICB, the FICB ...

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