Supra-Inguinal Fascia Iliaca (SIFI) Block - the SUPRA-INGUINAL approach
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- Опубліковано 17 чер 2024
- A how-to guide to performing a supra-inguinal fascia iliaca (SIFI) block using a needle insertion site ABOVE the inguinal ligament (i.e. a supra-inguinal approach). This is a useful alternative to the infra-inguinal approach to the SIFI block which I describe elsewhere (single-shot - • Ultrasound-guided Fasc... , catheter - • Femoral Nerve / Fascia... ).
It is a simple and safe technique - keep the needle insertion site more lateral, close to the ASIS, to avoid risk of contact with any critical structures.
A continuous catheter technique is described here - • Supra-Inguinal Fascia ...
This video is for informational and educational purposes only. It is not a substitute for professional medical advice, or consultation with a health care professional.
00:00 - Supra-inguinal vs infra-inguinal SIFI
00:58 - Indications & Principles
02:08 - Preparation
02:55 - Scanning
04:48 - Needling
05:21 - Video of block
2 questions
1) Must you visualise the lifting of the DCIA?
2) Is the fascia iliaca always directly below the DCIA - hence forth would positioning the needle just below the DCIA be another appropriate method?
I consider the DCIA more of a structure to be avoided rather than a surrogate endpoint target. It also usually sits superficial to transversus abdominis, so it's separated from fascia iliaca by this muscle. As such, I don't expect to see lifting of the artery, nor am I looking for it. I just want to avoid it as I insert the needle, and then I want to see spread under fascia iliaca pushing the muscle down. Hope that helps!
What is the indication for catheter , do you give intermittent blouses? Any problem with mobilization ?
if you want the flexibility to extend the block. You can run infusion or give int boluses as you wish. Quad weakness depends somewhat on LA conc - more dilute, less so. There can be a sweet spot for analgesia and mobility, but hard to give a one size fits all recipe in medicine.