07 Jul Nerve Blocks
Quick Links:
Fascia Iliaca Post & Fascia Iliaca Video
When to PENG or Fascia Iliaca?
Fractures above the intertrochanteric line (femoral neck), use the PENG block.
Fractures below the intertrochanteric line (including distal femur but NOT intra-articular knee fractures) use fascia iliaca.
Intertrochanteric fractures (on the line) use either.
What medication?
MD Calc Local Anesthetic Calculator – If you are mixing lido + longer acting, use the more toxic of the two drugs as your “cap”.
Nerve Block SETUP:
- Sterile towels
- 2-3 10cc flushes
- Chloraprep stick (the big ones, not the small ones for IVs)
- Sterile probe cover
- 40 or 55cc syringe
- Sterile gloves
- Echogenic nerve block needle
- Blunt 18g needle to draw up meds
- Nonsterile gel (for surveying prior to sterile prep)
- Medications: ropivacaine for long-acting block +/- lidocaine for skin wheel / needle trajectory
At UMC there is a one-stop shop for almost all these supplies in the supply room next to room 18. This should simplify the existing nerve block setup scavenger hunt. This is stocked by the ultrasound section meaning we are individually grabbing these supplies and putting them in a central location. If it runs low please email (emus@list.arizona.edu) / text one of us.
A word about the echogenic nerve block needle
The echogenic needles come with a wire used in regional anesthesia for supplying small voltages to assess muscle response to locate the needle in relation to the nerve. In emergency medicine we do not do this. To keep it less complicated, while sterile: grab the green base of the needle and firmly remove the electrical stimulation wire (it will pop out easily).