Regional anaesthesia & nerve blocks

Fascia iliaca compartment block

Now the standard of care in the UK for fractured neck of femur analgesia. Also works well for femoral shaft fractures (facilitates application of Thomas splint), hip dislocation and some knee fractures! The FICB targets the femoral nerve, obturator nerve and lateral cutaneous nerve of the thigh. Check out Core Ultrasound for a video demonstration.

Main 2 techniques are: 1) Infrainguinal approach and 2) suprainguinal approach. Choose one and learn it well! Good resources on ACEPNow and Highland EM. Note the differences in probe positioning, stick to one - they all achieve the same thing.

Blocks for rib fractures

serratus anterior plane block

Great block for rib fractures! This is a plane block which targets the lateral intercostal nerves. They are particularly useful in the trauma patient with spinal precautions as they can be performed in the supine position. For more information check out Highland EM Ultrasound and Life in the Fast Lane.

Erector spinae plane block

Relatively new to the game! The ESP block is showing a a lot of promise and may be safer to perform as lower risk of hitting pleura. It is particularly useful for posterior rib fractures but covers a wide area including lateral/anterior chest. Highland EM and Life in the Fast lane are excellent resources!

Forearm blocks

Interscalene Block

Another tool in your armamentarium for difficult shoulder reductions (particularly where sedation not possible or unsuccessful). Leads to a dense motor block which often itself causes shoulder to reduce without any manipulation due to muscle relaxation!

Lower limb blocks