Fascia iliaca block, infra-inguinal: find the fascia, then flood the plane

Question 1Where does the needle tip sit in an infra-inguinal fascia iliaca block?

1. aInside the femoral nerve sheath
2. bIn the subcutaneous fat over sartorius
3. cBetween the femoral artery and vein
4. dUnder fascia iliaca, on iliacus, lateral to the femoral nerve

Question 2Why is the dose the main safety concern in this block?

1. aLocal anaesthetic does not spread in this plane
2. bIt needs 30 to 40 mL, which brings the total dose close to the maximum for a frail patient
3. cThe block is always intravascular
4. dThe needle passes through the femoral artery

Question 3Which nerve does an infra-inguinal fascia iliaca block reach least reliably?

1. aThe branches to the anterior hip capsule from the femoral nerve
2. bThe obturator nerve
3. cThe nerve to the anterior thigh muscles
4. dThe femoral nerve

Question 4How does correct spread look on ultrasound?

1. aA bright swelling within iliacus
2. bFluid around sartorius above the fascia
3. cFluid separating fascia iliaca from iliacus and spreading along the plane
4. dFluid inside the femoral artery

Question 5What did a Cochrane review find for nerve blocks in hip fracture?

1. aBenefit only when given after surgery
2. bA higher rate of falls in the emergency department
3. cLess pain on movement and a lower risk of delirium and chest infection
4. dNo benefit over paracetamol alone