Fascia Iliaca

The femoral nerve block is used
for many different surgeries.
The femoral nerve block can be used for knee surgery,
hip surgery, femur surgery,
or even medial ankle surgery to get the saphenous nerve.
To perform the femoral nerve block,
there's a few key positioning tips.
We want to put the patient completely supine.
Many of our patients are larger and have larger abdomens,
so putting the patient supine allows us to get
high enough in the femoral region.
Also, if their adipose tissue hangs over the femoral region,
we want to put tape here and tape their abdomen away
out of the way, so you can put your probe
comfortably in the femoral region.
To do an ultrasound guided femoral nerve block,
we use a linear high frequency probe.
To start the femoral nerve block,
we usually put the probe right in the femoral crease.
On our screen now, we see several important features.
From medial to lateral, we see the Iliacus muscle,
we see the nerve sitting right on the Iliacus muscle,
and we also see the femoral artery,
and then to the right we see the femoral vein.
There are a few fascia coverings in this area
that are important.
The Facia Iliaca runs above the femoral nerve
and below the artery.
The Fascia Lata runs above all of this,
above the artery and vein as well.
Now for the femoral nerve, we want to see a hyperechoic
or bright nerve sitting on the Iliacus muscle.
The true femoral nerve is a wide, flat nerve
laying directly on the muscle.
If you inject above the Facia Iliaca,
this will create a barrier to your nerve
and allow a block that is not complete.
So as we move up and down the leg,
we're gonna see some key that will help you find
the femoral nerve in all patients.
More medially, you see the pulsating femoral artery,
and medial to that you see the femoral vein.
Here the vein collapses with pressure.
Now some keys to find the femoral nerve
in every patient are as follows.
If the probe is placed too cranially,
your femoral artery and vein and nerve
drop deep on the screen.
The femoral vein, artery, and nerve
are too deep, then you need to move the probe caudally.
If you probe is placed too distally,
that femoral artery is going to split
into two femoral arteries.
Here you can see a pulsating Profunda femoral deep
as well as a true femoral artery superficial.
Now I'm gonna put some color flow on that,
and you can see a pulsating artery deeper,
and a superficial femoral artery as well.
Now the vein is on the left,
represented in red in this picture.
As we move cranially, those two arteries come together.
When we look laterally from there,
the nerve has also come together from
many branches, forming one femoral nerve.
This way we can see the femoral nerve the best
when the artery also comes together as well.
Now our needle approach to the femoral nerve
is going to be from lateral to medial.
Typically, we use a 10-centimeter needle
because we use these in-plane approaches
to the femoral nerve.
I like to put my target on the further side of the screen
so I can see my needle coming in from the lateral side.
So I'll put my first injection lateral to the nerve
just above the Iliacus muscle
to ensure injection below the Fascia Iliaca
but not within the Iliacus muscle.
By using typical volume, such as 20 to 30 milliliters,
we'll get spread above the nerve
or below the nerve, without poking into
the nerve, and damaging the nerve.
In this femoral nerve block, you can see a single
injection needle being advanced lateral to the nerve
which is lying right on the Iliacus muscle.
You can see the pulsating femoral artery medially,
and the local anesthetic now spreading over
the wide, flat femoral nerve.
Our needle tracks in with the local anesthetic
so we can get local anesthetic spreading
all the way medial around the femoral nerve here.

Brightcove ID

5765925239001

https://youtube.com/watch?v=Z-O_EaAE_rg

Body

Dr. David Auyong reviews scanning techniques and sonographic landmarks for an ultrasound guided nerve block .

3D How To: Femoral Nerve Block

Read more about 3D How To: Femoral Nerve Block

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3D animation demonstrating an ultrasound guided femoral nerve block.

Clinical Specialties

Anesthesiology (Regional)

Media Library Type

How To Videos

Subtitles

- [Voiceover] A linear array transducer
with a nerve exam type is used to perform
an ultrasound-guided femoral nerve block.
The target depth is approximately one to three centimeters
in an 80 kilogram adult.
The patient is placed in a supine position.
The transducer is placed just superior
to the inguinal skin crease
with the orientation marker directed to the patient's right.
The common femoral artery is seen
as a round, pulsatile structure.
The transducer should be moved laterally
one to two centimeters to identify the femoral nerve.
The nerve lies deep to the fascia iliaca
and appears as an oblong, bright hyperechoic structure
lying on the iliacus muscle.
It may contain dark hyperechoic circles
that represent the nerve fascicles.
The nerve always lies deep to the fascia iliaca
and should not be confused
with the bright hyperechoic tissue lying above the fascia,
which is lymphatic tissue.
The needle is advanced using an in-plane technique.
The needle is positioned one to two centimeters lateral
to the transducer and advanced under the transducer.
The initial end point for the needle
is just lateral to the nerve and deep to the fascia iliaca.
The local anesthetic is injected incrementally,
close to the nerve.
For a successful block, a spread of local
should be observed behind the femoral artery.
If local anesthetic is identified anterior to the artery,
then the needle is superficial to the fascia iliaca
and the needle needs to be repositioned deeper.

Brightcove ID

5508117977001

https://youtube.com/watch?v=pCkjioc-EmQ

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M-Turbo: Femoral Nerve and Artery

M-Turbo: Femoral Nerve and Artery

How to: Femoral Nerve Block

How to: Femoral Nerve Block

3D How To: Femoral Nerve Block

3D How To: Femoral Nerve Block

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