History of the fascia iliaca compartment block

Abstract

Introduction : Endeavours to block the lumbar plexus have led to the development of multiple techniques and approaches to reach its different branches. Over the years, because of the evolution of radiographic techniques (CT-scan and MRI) and the introduction of ultrasound (US) guidance, several of these techniques were compared, re-evaluated and re-appreciated.

Methods : In this paper, a review on different manners to block the lumbar plexus was performed. Systematic Search in PubMed, Medscape, and ResearchGate was done with the following MeSH terms: fascia iliaca, fascia iliaca compartment, fascia iliaca compartment block, plexus blocks, “3:1 block” and regional anesthesia.

Results : Recently, the fascia iliaca compartment block (FICB) has regained interest in blocking the different branches of the lumbar plexus. By performing a FICB, the goal is to block the femoral nerve (FN), the lateral femoral cutaneous nerve (LFCN) and the obturator nerve (ON). This block evolved from a blind para-vascular infra-inguinal technique to an US guided supra-inguinal technique. The history of the FICB is discussed in this paper.(FN), the lateral femoral cutaneous nerve (LFCN), and the obturator nerve (ON) originate from the lumbar plexus and pass through this virtual space. Theoretically, these 3 nerves can be blocked by injecting local anesthetic agents (LA) under the FI with a single needle insertion, and subsequently provide additional postoperative analgesia for major hip and knee surgery in an elegant and minimal invasive way.

The goal of this paper is to clarify the history of the different approaches of the FICB. The FICB evolved from a blind para-vascular infra-inguinal technique to an ultrasound (US)-guided supra-inguinal technique. An important landmark for these different approaches is the place of injection of the LA with regard to the inguinal ligament (IL). Recently, the supra-inguinal approach has gained popularity over the infra-inguinal approach.