Suprainguinal fascia iliaca compartment block in pediatric-aged patients: An educational focused review
Regional anesthesia has become an integral component of postoperative analgesia and multimodal analgesia during surgery, providing opioid sparing effects and maintaining a beneficial adverse effect profile. Although neuraxial techniques were initially the primary techniques used for intraoperative a...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-01-01
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| Series: | Saudi Journal of Anaesthesia |
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| Online Access: | https://journals.lww.com/10.4103/sja.sja_467_24 |
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| author | Anuranjan Ghimire Sidhant Kalsotra Joseph D. Tobias Giorgio Veneziano |
| author_facet | Anuranjan Ghimire Sidhant Kalsotra Joseph D. Tobias Giorgio Veneziano |
| author_sort | Anuranjan Ghimire |
| collection | DOAJ |
| description | Regional anesthesia has become an integral component of postoperative analgesia and multimodal analgesia during surgery, providing opioid sparing effects and maintaining a beneficial adverse effect profile. Although neuraxial techniques were initially the primary techniques used for intraoperative and postoperative anesthesia and analgesia, many of these techniques have been replaced by selective nerve blockade. This has been facilitated by the widespread use of ultrasound-guided over conventional landmark techniques. Fascia iliaca compartment blockade (FICB) is performed by depositing a local anesthetic agent underneath the FI fascial sheath which lies on top of the iliopsoas muscle. With the landmark technique, the FICB is more commonly applied using an approach below the inguinal ligament. Advancements in the use of ultrasound have led to development of a potentially superior suprainguinal fascia iliaca (SIFI) block for hip and thigh surgery. An improved cephalad distribution of the local anesthetic solution within the fascia iliaca compartment and comparable analgesic efficacy compared to the more invasive lumbar plexus block has resulted in increased use of the SIFI block in both adults and pediatric-aged patients. The SIFI block aims to target the femoral nerve (FN), lateral femoral cutaneous nerve (LFCN), and obturator nerve (ON), thus providing analgesic coverage for hip, femur, and thigh surgery. Although the FN and LFCN are reported to be consistently blocked by the suprainguinal approach, blockade of the ON may be less reliable and requires a higher volume of the local anesthetic agent, proving this technique to be a volume-dependent block. A lower volume of local anesthetic solution may be associated with block failure, especially in the area supplied by the ON and less frequently in the distribution of the LFCN. Thus, local anesthetic concentration must be adjusted in smaller children and infants to maintain effective volume while not exceeding local anesthetic dosing limitations. The current manuscript reviews the innervation of the lower extremity including the anatomy of the fascia iliaca compartment, outlines different approaches for the fascia iliaca block, and reviews the current practice of SIFI blockade in adults and children. |
| format | Article |
| id | doaj-art-a03df6d3196c48ffa236052c3fd6fce9 |
| institution | Kabale University |
| issn | 1658-354X 0975-3125 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Saudi Journal of Anaesthesia |
| spelling | doaj-art-a03df6d3196c48ffa236052c3fd6fce92025-02-06T07:24:16ZengWolters Kluwer Medknow PublicationsSaudi Journal of Anaesthesia1658-354X0975-31252025-01-01191657610.4103/sja.sja_467_24Suprainguinal fascia iliaca compartment block in pediatric-aged patients: An educational focused reviewAnuranjan GhimireSidhant KalsotraJoseph D. TobiasGiorgio VenezianoRegional anesthesia has become an integral component of postoperative analgesia and multimodal analgesia during surgery, providing opioid sparing effects and maintaining a beneficial adverse effect profile. Although neuraxial techniques were initially the primary techniques used for intraoperative and postoperative anesthesia and analgesia, many of these techniques have been replaced by selective nerve blockade. This has been facilitated by the widespread use of ultrasound-guided over conventional landmark techniques. Fascia iliaca compartment blockade (FICB) is performed by depositing a local anesthetic agent underneath the FI fascial sheath which lies on top of the iliopsoas muscle. With the landmark technique, the FICB is more commonly applied using an approach below the inguinal ligament. Advancements in the use of ultrasound have led to development of a potentially superior suprainguinal fascia iliaca (SIFI) block for hip and thigh surgery. An improved cephalad distribution of the local anesthetic solution within the fascia iliaca compartment and comparable analgesic efficacy compared to the more invasive lumbar plexus block has resulted in increased use of the SIFI block in both adults and pediatric-aged patients. The SIFI block aims to target the femoral nerve (FN), lateral femoral cutaneous nerve (LFCN), and obturator nerve (ON), thus providing analgesic coverage for hip, femur, and thigh surgery. Although the FN and LFCN are reported to be consistently blocked by the suprainguinal approach, blockade of the ON may be less reliable and requires a higher volume of the local anesthetic agent, proving this technique to be a volume-dependent block. A lower volume of local anesthetic solution may be associated with block failure, especially in the area supplied by the ON and less frequently in the distribution of the LFCN. Thus, local anesthetic concentration must be adjusted in smaller children and infants to maintain effective volume while not exceeding local anesthetic dosing limitations. The current manuscript reviews the innervation of the lower extremity including the anatomy of the fascia iliaca compartment, outlines different approaches for the fascia iliaca block, and reviews the current practice of SIFI blockade in adults and children.https://journals.lww.com/10.4103/sja.sja_467_24infrainguinal fascia iliaca blocklumbar plexusregional anesthesiasuprainguinal fascia iliaca block |
| spellingShingle | Anuranjan Ghimire Sidhant Kalsotra Joseph D. Tobias Giorgio Veneziano Suprainguinal fascia iliaca compartment block in pediatric-aged patients: An educational focused review Saudi Journal of Anaesthesia infrainguinal fascia iliaca block lumbar plexus regional anesthesia suprainguinal fascia iliaca block |
| title | Suprainguinal fascia iliaca compartment block in pediatric-aged patients: An educational focused review |
| title_full | Suprainguinal fascia iliaca compartment block in pediatric-aged patients: An educational focused review |
| title_fullStr | Suprainguinal fascia iliaca compartment block in pediatric-aged patients: An educational focused review |
| title_full_unstemmed | Suprainguinal fascia iliaca compartment block in pediatric-aged patients: An educational focused review |
| title_short | Suprainguinal fascia iliaca compartment block in pediatric-aged patients: An educational focused review |
| title_sort | suprainguinal fascia iliaca compartment block in pediatric aged patients an educational focused review |
| topic | infrainguinal fascia iliaca block lumbar plexus regional anesthesia suprainguinal fascia iliaca block |
| url | https://journals.lww.com/10.4103/sja.sja_467_24 |
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