Fascia iliaca compartment block: How far does the local anaesthetic spread and is a real time continuous technique...

Area of Science:

• Pediatric Anesthesiology
• Regional Anesthesia
• Pain Management

Background:

• The fascia iliaca compartment block (FICB) is frequently used for anterolateral thigh surgery in children.
• The precise spread of local anesthetic (LA) within fascial layers in pediatric patients remains unclear.
• This study investigated the potential for LA to reach the lumbar plexus with standard FICB doses in children.

Purpose of the Study:

• To fluoroscopically assess the extent of LA spread following FICB in pediatric patients.
• To evaluate the efficacy and safety of continuous FICB catheters for intraoperative and postoperative analgesia in children.
• To determine if the standard FICB dose in children can reach the lumbar plexus.

Main Methods:

• Ultrasound-guided FICB was performed on 25 children (aged 1-15 years) undergoing lower limb surgery.
• Radio-opaque dye was added to the LA, and fluoroscopy was used to visualize spread.
• Continuous catheters were placed under ultrasound guidance for ongoing analgesia.

Main Results:

• Fluoroscopy confirmed visualization of anatomical landmarks and needle placement in all patients.
• Local anesthetic spread to the lumbar plexus was not observed in 20 patients (80%).
• In 5 patients (20%), the LA delineated the psoas muscle and reached the L4 vertebral level, providing adequate analgesia with 92% achieving sufficient postoperative pain relief. Mild catheter soakage was noted.

Conclusions:

• Single-shot FICB demonstrates limited LA spread in children but is efficacious.
• Continuous FICB is a feasible and effective method for analgesia in pediatric patients undergoing lower limb surgery.
• While not consistently reaching the lumbar plexus, FICB provides significant pain relief.