From the Guidelines
For a fascia iliaca block, the recommended dose of ropivacaine is 0.2-0.5 ml/kg of 0.2% concentration, as suggested by the most recent and highest quality study 1. This dose is appropriate for ensuring adequate spread within the fascial plane to block the femoral, lateral femoral cutaneous, and occasionally obturator nerves.
- The use of sterile technique is crucial when performing the block.
- Consider adding epinephrine (1:200,000 or 5 μg/ml) to reduce systemic absorption and prolong the block duration.
- Ultrasound guidance is recommended to visualize the fascial planes and ensure proper needle placement beneath the fascia iliaca and above the iliopsoas muscle.
- Onset of sensory blockade typically occurs within 15-30 minutes, with duration of approximately 8-12 hours for single-shot blocks.
- For pediatric patients, reduce the dose proportionally based on weight, typically using 0.2-0.5 ml/kg of 0.2% ropivacaine, as supported by 1 and 1. This block provides effective analgesia for hip, anterior thigh, and knee procedures while avoiding motor blockade when lower concentrations are used. Key points to consider:
- Maximum safe dose of ropivacaine is 3 mg/kg, as indicated in 1.
- The dose of ropivacaine for a fascia iliaca block may vary depending on the patient's weight and the specific procedure being performed. However, the most recent and highest quality study 1 suggests using 0.2-0.5 ml/kg of 0.2% ropivacaine.
From the Research
Effective Volume of Ropivacaine for Fascia Iliaca Block
The effective volume of ropivacaine for fascia iliac block can vary depending on the concentration and the patient population.
- A study published in 2006 2 found that the effective volumes of 0.5% ropivacaine capable of producing a block in 50%, 95%, and 99% of cases were estimated to be 28.8 mL, 34.3 mL, and 36.6 mL, respectively.
- Another study published in 2020 3 determined the 50% effective volume (EV50) and the 95% effective volume (EV95) of 0.25% ropivacaine for ultrasound-guided supra-inguinal fascia iliaca compartment block to be 15.01 mL and 26.99 mL, respectively.
Concentration and Volume of Ropivacaine
The concentration and volume of ropivacaine used for fascia iliac block can also impact the effectiveness and safety of the block.
- A study published in 2004 4 found that the administration of ropivacaine 3.5 mg/kg can be associated with sustained high plasma concentrations of ropivacaine, outside the tolerable range, and recommended the use of lower ropivacaine dosage during fascia iliaca compartment block in children.
- A study published in 2019 5 investigated the pharmacokinetics of ropivacaine at different concentrations in elderly patients and found that both 0.375% and 0.5% ropivacaine held an efficiently analgesic effect for fascia iliaca compartment block, but suggested that a lower concentration may be a safer option for a single large volume of block.
Safety and Efficacy of Ropivacaine for Fascia Iliaca Block
The safety and efficacy of ropivacaine for fascia iliaca block have been demonstrated in several studies.
- A study published in 2011 6 found that the administration of 0.2% ropivacaine for fascia iliaca compartment block in children with developmental dislocation of the hip had the advantages of safety, precision, long-lasting, and convenience.
- The study published in 2006 2 found that the volumes of 0.5% ropivacaine and 0.5% bupivacaine with adrenaline 1:200,000 for the fascia iliaca block are similar, suggesting that ropivacaine can be a suitable alternative to bupivacaine for this type of block.