林必盛中国医药学麻醉部.pptVIP

林必盛 中國醫藥大學 麻醉部 Indications The Fascia Iliaca Compartment Block (FICB) is a simple block for post-operative pain relief for procedures and injuries involving the hip, anterior thigh, and knee.? This block is useful, pre and post-operatively, for fractures of the hip and proximal femur, as well as total hip and knee arthroplasties. Anatomy of the Fascia Iliaca Block Lateral Femoral Cutaneous nerve The Lateral Femoral Cutaneous nerve is a purely sensory nerve arising from the L2 L3 nerve roots that provides sensation from the iliac crest down the lateral portion of the thigh to the area of the lateral femoral condyle.? The lateral femoral cutaneous nerve emerges from the lumbar plexus and travels downward lateral to the psoas muscle and crosses the iliacus muscle deep to the iliacus fascia. Obturator nerves The anterior and posterior Obturator nerves innervate a portion of the distal, medial thigh.? They arise from the L2, L3, L4 nerve roots and cross the iliacus muscle, deep to the fascia, to the medial thigh.? The obturator nerves are sometimes involved in the FICB but probably plays little role in post-operative pain relief for most surgeries of the hip and proximal femur. Iliacus muscle The Iliacus muscle is a large, flat, triangular muscle that lines and fills the ilium.? It originates from all along the upper portions of the ilium and iliac crest, sacrum and iliolumbar ligaments.? The iliacus muscle joins with the lateral side of the psoas major muscle.? Together they are referred to as the iliopsoas.? The iliopsoas exits the pelvis from beneath the inguinal ligament, wraps around the proximal neck, and inserts into the lesser trochanter, acting as a powerful hip flexor. Fascia Iliaca The fascial covering of the iliopsoas is thin superiorly, becoming significantly thicker as it reaches the level of the inguinal ligament.? This thickness provides a great deal of resistance and a large “pop” as a needle tip is passed through the fascia.? Lumbar plexus The lum