ESRA Academy. Lewinsohn B. Sep 8, 2016; 138225; 0042 Topic: Lower Limb Blocks - Femoral Nerve Block (including Fascia Iliaca and Saphenous Nerve Block)
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Bradley Lewinsohn
Bradley Lewinsohn

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Background and Aims:

The use of real time ultrasound guided fascia Iliaca blocks is regarded as a gold standard method, and has diminished the use of the landmark, double pop technique. The recently described sartorius roll (a fingertip roll of the sartorius muscle) is a reliable anatomical landmark that may assure the continuing use and efficacy of landmark based techniques, providing it results in correct needle position. We propose to observe the needle tip position using ultrasound.


After audit committee approval, hip trauma patients undergoing surgery received a traditional landmark based fascia iliaca block, using the sartorius roll method. The final needle-tip position was identified (by a separate experienced anaesthetist) using ultrasound.  If incorrect (i.e. not directly under the fascia iliaca or within the iliacus muscle), the needle was repositioned using ultrasound.


Twenty adult patients were studied. Seven patients had the needle tip under the fascia iliaca.  In 13 patients, the tip was within the iliacus muscle. In one patient, the needle was within the sartorius muscle.16 patients needed no immediate postoperative analgesia.


Our success compares favourably with the classical method described by Dalens et al. Despite intramuscular injection, the blocks still resulted in good postoperative analgesia, possibly by posterior and caudal spread of local anaesthetic. In the absence of ultrasound, we encourage the use of the Sartorius roll as a reliable anatomical adjunct.

1. Anaesthesia News August 2015: Issue 337
2. ISRN Anaesthesiology (2011): Article ID 421505
3. Ultrasound guided fascia iliaca block. A comparison with loss of resistance technique RAPM 2008 Nov-Dec:33(6): 526-31

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