Combination of a deep fascia iliaca block with ultra-low dose spinal anesthesia for hip fracture surgery

Minimum effective concentration of ropivacaine for ultrasound-guided transmuscular quadratus lumborum block in total hip arthroplasty: a randomized clinical trial

“…Eighth, although good postoperative analgesia in THA patients was provided by transmuscular QLB, the patients were placed in lateral decubitus position during the block, which reduced the comfort of patients. Almeida proposed the LALaT block, 34 DeFI block 35 and the PPIP. 36 These three blocks were performed on supine position, which could improve the comfort of patients.…”

Deep fascia iliaca block combined with sacral plexus block for hip fracture surgery: A retrospective series of cases

“…The muscular, cutaneous, and osseous innervation for the hip from the sacral plexus rely on the nerves to quadratus femoris gemellus inferior, gluteus inferior, and gluteus superior. [ 2 , 3 ] While the lumbar plexus is responsible for the anterior capsule innervation, where a high density of nociceptors are present, the sacral plexus is responsible for the posterior capsule innervation, where, in opposition to the anterior capsule, a high density of mechanoreceptors are present. [ 2 - 4 ]…”

“…The DeFI block should allow a reliable blockade of the anterior branches of the lumbar plexus due to a different injection site from the supra-inguinal fascia iliaca (S-FI) block. [ 3 ] A study conducted by Vermeylen et al . [ 5 ] demonstrated that an effective ON block after an S-FI block depends on the ability of the LA to reach the posterior-medial border of the psoas major muscle (PMM) at a level above the body of S1 vertebra.…”

The novel proximal para-iliopsoas (PPIP) block for hip surgery: A technical report

“…Several alternative approaches to the suprainguinal fascia iliaca (FI) block,[ 1 ] such as the circumpsoas block and the anterior iliopsoas plane block, targeting the FI compartment in the anterior surface of the psoas major muscle (PMM), have been proposed; nevertheless, the cranial and posterior spread of local anaesthetic may be unpredictable because cranial approaches would impinge on intraabdominal contents. [ 2 ]…”

“…This approach has a different injection point—more cranial, medial and posterior—from the suprainguinal FI block. [ 1 ] The ultrasound probe is oriented obliquely from the anterior superior iliac spine (ASIS) (1 cm distally and medially) towards the umbilicus [ Figure 1 ]; at L5-S1 level, the iliac bone is seen as a J-shaped hockey stick, instead of a straight line that terminates medially in the vicinity of the medial edge of the iliacus muscle (IM); the FI covers the IM and PMM anteriorly, but not the iliopsoas space[ 2 ]; additionally, an interosseous gap medial to the iliac bone identifies the sacroiliac joint (SIJ) [ Figure 1 ].…”