Name:
ACA- Hadzic- Peripheral Nerve Block 3e- The Hip Block
Description:
ACA- Hadzic- Peripheral Nerve Block 3e- The Hip Block
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/d4145c1f-536e-42e2-b82d-41d68878acae/thumbnails/d4145c1f-536e-42e2-b82d-41d68878acae.jpg?sv=2019-02-02&sr=c&sig=CCrDBLGZEn63hWB5QBwPmmavTiWvKyp9HlwioMfb%2BZ4%3D&st=2025-05-13T06%3A22%3A50Z&se=2025-05-13T10%3A27%3A50Z&sp=r
Duration:
T00H04M20S
Embed URL:
https://stream.cadmore.media/player/d4145c1f-536e-42e2-b82d-41d68878acae
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/d4145c1f-536e-42e2-b82d-41d68878acae/ACA- Hadzic- Peripheral Nerve Block 3e- The Hip Block.mov?sv=2019-02-02&sr=c&sig=J%2FC0Ebbws%2B6jRpzkIGJpuxX07Pa82YzL%2F3ja74rLaQY%3D&st=2025-05-13T06%3A22%3A51Z&se=2025-05-13T08%3A27%3A51Z&sp=r
Upload Date:
2022-02-27T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
DIGITAL INTRO TUNE:
DR. HADZIC: And we start with the external anatomy. External anatomy here points out that this is the femoral crease, that is the anterior superior iliac spine. So clearly, from the anterior superior iliac spine to the pubic tubercle, that's the inguinal ligament, and in here just for orientation, this is the femoral crease. So we're going to position the transducer on the femoral crease, with an intention to localize the femoral artery and the femoral nerve to it.
DR. HADZIC: So here we have the ultrasound is now positioned to five centimeter depth. Here we can more clearly see the femoral artery, right there, the femoral nerve, and here we can see the part of the hip joint or hip capsule. Okay, so once we see this image, this is the iliacus muscle, this is the fascia iliaca here as well, once we see this image, we want to go slightly proximal, until we lose the hip joint, and we start seeing here the pubic ramus.
DR. HADZIC: Now we have to continuously keep the femoral artery and the femoral nerve in the view that now is in the image, until your inferior iliac spine. So our goal now is to adjust this image to tweak it up so we can clearly see the femoral artery, the femoral nerve, the psoas muscle tendon, the iliacus muscle, and the anterior inferior iliac spine. And then the technique consists of placing a needle to scrape by the anterior inferior iliac spine and to land on the pubic ramus, where we inject the local anesthetic to layer out underneath the iliacus muscle.
DR. HADZIC: Even though this is not a nerve block technique per se, we actually prefer always using nerve stimulation. And the purpose for using a nerve stimulator is that it is not uncommon that our trainees direct the needle towards the femoral nerve, which is something that we definitely want to avoid. Likewise, we use injection pressure monitoring to rule out an injection into the tendon or rather underneath the iliacus muscle.
DR. HADZIC: Okay. So the needle insertion will be very steep. Here we're using an in-plane approach, and we can see the needle, how it approaches the anterior inferior iliac spine, we need to use a little steeper angle, and the needle eventually lands right on the pubic ramus, slightly lateral to the tendon of the psoas muscle. Aspiration here is negative. The twitch is absent, and injection pressure is low.
DR. HADZIC: And here we can see layering of the local anesthetic over the ramus pubis, and at the same time, we can see how the iliacus muscle has been lifted by the injection of the local anesthetic. Local anesthetic tracks underneath the psoas muscle as well. And that's one simple injection to accomplish analgesia after until your hip replacement surgery. As we remove the needle there, we're going to freeze the image one more time we're going to freeze the image one more time and use the drawing tools to depict what we've actually done.
DR. HADZIC: So that's the anterior inferior iliac spine, an injection of a local anesthetic, as you can see, layers underneath the iliacus muscle, in order to fill the space between the iliacus muscle and the ramus pubis, and that's where the articular branches of the lumbar plexus and that's where the articular branches of the lumbar plexus and the femoral nerve are passing onto the anterolateral capsule of the hip.
DIGITAL OUTRO TUNE:
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