SAQ 287 – Procedural – fascia iliaca block for fractured neck of femur
Model Answer
Procedural – fascia iliaca block for fractured neck of femur.
a. Acute complications
- Inadequate analgesia or failed procedure.
- Intravascular injection or local-anaesthetic systemic toxicity.
- Neural injury to femoral, obturator, or lateral femoral cutaneous nerve.
- Vascular injury or bleeding from femoral vessels.
- Infection, or allergy/anaphylaxis.
b. Anaesthetic agent
| Drug | Total dose | Final volume |
|---|---|---|
| Bupivacaine 0.5% | 2-2.5 mg/kg; maximum about 85 mg in this 35 kg patient | Large volume, at least 30 mL. |
| Ropivacaine 0.75% | 2-3 mg/kg; maximum about 105 mg in this 35 kg patient | Large volume, at least 30 mL. |
c. Delirium prevention
- Frequent reorientation and family engagement.
- Continue usual medications and avoid sedative or hallucinogenic drugs.
- Maintain hydration and nutrition with regular meal times.
- Bladder care, toileting, and management of alcohol-withdrawal risk where relevant.
- Treat causes of the fall or delirium such as infection or stroke.
- Maintain day-night cues, quiet environment, glasses/hearing aids, familiar objects, and consistent staff presence.
- Early operative repair to minimise immobility.
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