The SIFI block and When to Apply It With Katherine Vlasica and Megan Yu

This week on the podcast we have two special guests: Katherine Vlasica and Megan Yu. Dr. Katherine Vlasica works as and attending physician at Saint Joseph’s Health in New Jersey, and Dr. Megan Yu is a resident at the Yale emergency medicine residency. In this weeks podcast, we talk about different methods of blocking femur and hip injuries, including parenteral medications, the PENG block, the suprainguinal fascia iliaca block and the infrainguinal fascia iliaca block. Check it out!

Check out the corresponding 5 Minute Sono Videos Below:

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  1. Hi, I have some comments on this segement. Great topic and very important in clinical practice!!

    I do like the Sifi block – BUT can’t it be fully replaced by the PENG block, at least when treating intracapsular # NOF? The SiFi is wonderful when in can be performed easily i.e. on slim and co-operative patients. With our average …. say…. BMI positive patients you really need a pannus retractor (a live person or some sort of device which I have not come across yet!) to get the masses of tissue out of the way. Putting patients in Trendelenburg might help a bit here, but the patient needs to be able to tolerate this. Even then the respirations of the patient often generate an undulating up & down movement of the probe, which can make this quite tricky at times.

    On the other hand: The PENG block. I know that for this you usually have to use the curvilinear probe, whereeas the SiFi block can usually be done with the linear probe. Also – the needle trajectory for the PENG block is much steeper, theoretically making needle visibility more challenging.

    HOWEVER – my observation is that needle visibility with the curvilinear probe (with MSK settings) is often surprisingly good – despite a relatively steep angle. I would even go one step further and say it is often easier than with the linear probe!! I wonder why this is and whether other people have made similar observations?! I have no idea to explaind this though – could it be that the slice thickness of a curvilinear probe is larger than the paper thin slice thickness of a linear probe? Moreover, I find the PENG block easier for another reason: The probe gets placed somewhat more distal i.e. away from the rocking & rolling abdominal muscles. Moreover, hitting bone is such a safe backstop!

    For the fractures distal to the joint capsule – can’t we resort to the ‘good old’ infra-inguinal FIB instead, perhaps with emphasis on bathing the femoral nerve?

    I’d be curious to find out what people think!

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