FICB for Hip Arthroscopy and Fracture

 Wawona Tunnel Yosemite N.P. - photo by JoAnn Sturman

There has been some discussion within the group regarding the use of Fascia Iliaca Nerve Block or more correctly Fascia Iliaca Compartment Block in hip arthroscopy and hip fracture cases for post op pain RX.  I recently asked Dr. Jack Vander Beek of Neuraxiom.com to comment. 

To: Dr. Jack Vander Beek
 contact@neuraxiom.com

Subject: FINB/FICB for post op pain RX for hip arthroscopy

I work in a group of about 35 anesthesiologists.  We have an active regional anesthesia program.  Recently I forwarded your FINB tutorial to the group. Some of us are using the technique primarily for post op pain RX for hip
fractures.

The orthopedic group performs hip arthroscopy - primarily debridement and femoroplasty.  The surgeon typically injects local into the joint at the end of the case, but unlike knee scopes, the level of analgesia is quite unpredictable.

Two questions:

1.  Do you think FINB would be effective for post op pain RX in hip arthroscopy?

2.  I mentioned this technique to a partner who responded, "Why not just do a femoral block?"  Could you explain why the FINB is more efficacious for surgery on the hip joint than femoral nerve block?

Thank you.  Your site is very helpful and informative.

Scott Sturman MD
Fresno, CA


Dr. Sturman,

Thanks for writing and for your kind words about my site.

I think your use of the FICB or FINB for hip fracture is a great use for the block.  If you've tried the block for Total Hip Arthroplasties (THA) you probably have noticed that in some cases it works quite well and in others there can be residual pain from the posterior capsule. The sciatic innervates the posterior capsule in most people therefore injury to that anatomical portion is untouched by the block. Personally I think the block is worthwhile in most THAs.  It just shouldn't be oversold to the patients as one that will make them pain-free.

I would think that the FICB would work well for the hip arthroscopy. It is easy to perform prior to surgery and has a low rate of problems. As for the difference between it and the femoral nerve block and any advantages, you can achieve the same end using the femoral nerve block technique in some patients. This was the basis of Alon Winnie's 3 in 1 technique. The point was to place the needle point beneath the iliopsoas fascia and inject while
applying manual pressure distal to the injection, presumably forcing the local solution cephalad along the pathway taken by the nerves of the lumbar plexus.

The difference between the femoral approach and the FICB is that in the FICB the needle tip is placed proximal to the femoral site and uses the edge of the ilium and direction of the muscle fibers to distribute the local solution cephalad so it intercepts the nerve of the lumbar plexus. I think the FICB approach is more consistent in reaching those nerves supplying the hip joint. You still get an effective femoral block as well.

The reproducibility of the distribution makes the FICB preferable to the femoral approach in my opinion, but of course that is just what it is, my opinion.  I hope that this helps and is clear.

Please let me know what you think and thanks again for writing.  

Best regards,
Jack Vander Beek
jack@neuraxiom.com