Supra-Inguinal Fascia Iliaca (SIFI) Catheter Insertion - the SUPRA-INGUINAL approach

[@streen2000]

Wonderful Prof. Would you consider this a deep block, with respect to concurrent anticoagulants/antiplatelet therapy? Especially given the use of larger bore needle with catheter placements

[@KiJinnChin]

Good question. It will be deeper in some than others; but in a slim patient, you could compress the site quite effectively against the bony ilium if there was a concern.. I think if you stay more lateral, and avoid the branches of the deep circumflex iliac vessels, it is as safe as any other fascial plane block. It's worth noting that the Pajunk E-cath II has a 21G needle (within an 18G introducer cannula), so that may offer some added safety vs a 17G Tuohy needle with other sets.

[@joelchan7477]

@@KiJinnChin is there any difference between using a tuohy needle versus a pajunk? I feel that with a tuohy (blunt tip) i m almost always going intramuscularly instead of between fascia planes though i m seemingly in the right location. Could be due to its echogenicity?

[@KiJinnChin]

@@joelchan7477 I can't say for sure if needle tip makes a huge difference. I will say that trying to be within and open up a POTENTIAL interfascial plane is always hard. Most of the time the first injection is in the wrong layer, either slightly too superficial or too deep. The best advice I have is - to survey carefully as you test inject, and make fine adjustments to the tip as needed. I do think in general that blunt-tip needles are better because, if you are sufficiently mindful of tactile feedback from the tip, you can get a sense of if you have pierced a single fascial layer, which allows you to be very precise in advancing forward.

[@simonrochus]

How do you give local anesthetic per the catheter? Via bolus or with a continuous infusion? What dosing regimen and LA do you typically use? Thank you for your wonderful work, kind regards from Europe.

[@KiJinnChin]

You can do either - depending on your resources. We only have automated continuous infusion, not int boluses - so those would have to be given manually. CI works quite well; and again with a catheter you have the flexibility to vary dosing, and LA type. Something more dilute along the lines of 0.2% ropivacaine or 0.25% bupivacaine usually provides noticeable benefit, and has a better chance of preserving more quads motor function (e.g. straight leg raise), although cannot guarantee full strength.