Comparison of the Fascia Iliaca Compartment Block with the 3-in-1 Block in Children

TLDR

A multieffective block can only develop when local anesthetic is introduced behind the fascia iliaca, which encloses a space through which the femoral, lateral cutaneous, and obturator nerves travel. The study introduces a new single‑injection fascia iliaca compartment block to anesthetize the femoral, lateral cutaneous, and obturator nerves. The block is performed by injecting local anesthetic behind the fascia iliaca at the junction of the lateral and medial thirds of the inguinal ligament, compressing upward, and was prospectively tested in 60 children versus 60 controls receiving a 3‑in‑1 block. The fascia iliaca compartment block achieved adequate analgesia in over 90% of children, compared to only 20% with 3‑in‑1 blocks, and its success was not due to needle misplacement, leading the authors to recommend it for pediatric use.

Abstract

A new single injection procedure, the fascia iliaca compartment block, is described for blocking the femoral, lateral cutaneous, and obturator nerves. The technique consists of injecting a local anesthetic immediately behind the fascia iliaca at the union of the lateral with the two medial thirds of the inguinal ligament, and forcing it upward by finger compression. This block was prospectively evaluated in 60 pediatric patients aged 0.7 to 17 years undergoing surgery of the lower limb, and then compared with a similar group of 60 children given a 3-in-1 block. Adequate analgesia was only obtained in 20% of the patients given 3-in-1 blocks (group 1), whereas the fascia iliaca compartment block proved to be easy, free of complications, and effective in more than 90% of patients (group 2). Such a high failure rate in group 1 was not due to misplacement of the needle since a femoral nerve block developed in all patients. Therefore it is unlikely that the local anesthetic can spread rostrally towards the lumbar plexus then return peripherally along the issuing nerves, and this was, indeed, not confirmed by radiological findings. In the authors' opinion, a multieffective block can only develop when the local anesthetic is introduced behind the fascia iliaca, which circumscribes a potential space where the femoral, lateral cutaneous, and obturator nerves run for a considerable part of their course. This report shows that deliberately injecting this space almost always results in an easy and effective block of these three nerves. The fascia iliaca compartment block can be recommended for use in children.