Fascia Iliaca Compartment Block

The technique aims at injecting a local anesthetic at the inner surface of the fascia iliaca, expecting its spread towards the lumbar plexus nerves as they emerge from the psoas com-partment. The child is placed in the dorsal recumbent position. A short-beveled needle is inserted perpendicularly to the skin, 0.5-1 cm below the union of the lateral with the two medial thirds of the skin projection of the inguinal ligament (Figure 2). A first give (crossing of the fascia lata) then a second one (crossing of the fascia iliaca), each followed by a loss of resistance, are sought before the local anesthetic is injected (Table 2). Distribution of anes-thesia involves the territories of the femoral and lateral cutaneous nerves. In addition, the obturator nerve is blocked in approximately 80% of cases. The technique is extremely easy to perform and safe. Introducing a catheter below the fascia iliaca allows continuous or disconti-nuous infusion of local anesthetics which permits long lasting or intermittent analgesia (wound dressings, joint mobilization, etc) (21,44). Continuous infusions are usually performed using 0.125% bupivacaine or 0.2% ropiva-caine at rates ranging from 5 to 10 mL/h (this dose can be adjusted by titration later on) and/or on-demand top up doses, allowing patient-controlled analgesia are well appreciated even by rather young patients (from 6 years of age approxima-tely). The use of more concentrated solutions and larger infusion volumes can occasionally be administered without significantly increasing the danger of systemic toxicity.