A fascia iliaca block (FIB) is a regional anaesthetic technique where local anaesthetic is deposited beneath the fascia iliaca to block the femoral, lateral femoral cutaneous, and often obturator nerves. It is commonly used for analgesia in hip and proximal femur fractures, particularly neck of femur fractures. Approaches include the landmark (anatomical) technique, which will be discussed in further detail here, and ultrasound-guided technique. While landmark FIB remains practical where ultrasound is unavailable, ultrasound-guided FIB is considered the gold standard, offering higher accuracy, improved analgesia, reduced opioid use, and enhanced safety.
Contraindications
Absolute
- Patient refusal
- Documented true allergy or anaphylaxis to local anaesthetic
- Local infection at the inguinal site
- Previous femoral-bypass surgery or near a graft site
- Anticoagulation – if INR >1.5 or treatment dose NOAC or LMWH or if platelets <80
Relative
- Respiratory rate <10
- Systolic blood pressure <90mmHg
- Patient agitation/unable to co-operate
- Acutely unwell patients (e.g. septic/MI/respiratory failure)
Surface Anatomy
Equipment
- Sterile wound care pack (S/M/L sized gloves pre-contained)
- 2 x 20ml Leuer lock syringes
- Blunt red filling needle
- Skin prep solution (chlorhexidine or iodine)
- 0.25% Levobupivacaine
- Patient weight <50kg – single dose 30mls
- Patient weight >50kg – single dose 40mls
- 5ml syringe with a 25G needle for subcutaneous infiltration
- 2ml 1% lidocaine for the skin
Procedure
- Introductions, consent, check patient identifiers. Administer simple analgesia pre-procedure if required and allow time for this to work.
- Position patient supine and assess baseline neurovascular status of the affected limb. Ensure IV access and monitor oxygen saturations, HR, BP, RR.
- Wash hands. Open wound care pack and prepare kit maintaining asepsis
- Draw up LA for the block and for the skin
- Wash hands, and don apron and sterile gloves from wound care pack
- Clean area and palpate anterior superior iliac spine (ASIS) and pubic tubercle
- As in the image, divide the resulting line into thirds and identify the femoral pulse.
- 2cm below the index finger of the lateral hand identifies the site of needle insertion for the block. If unclear about landmarks, stop and seek assistance.
- Keeping this finger in position anaesthetise the skin with 1% Lidocaine at the insertion site.
- Insert the red needle used for the block at a right angle to the skin until pierced.
- Once through the skin, adjust the needle angle to 60° cephalad. Do not direct the needle medially.
- Advance the needle feeling for two distinct ‘pops’ (piercing the fascia lata then the fascia iliaca)
- Attempt aspiration, and if negative, inject the Levobupivacaine incrementally (5mls at a time, re-aspirating each time).
- Stop if there is pain, paraesthesia or excessive resistance on injection. Injection should flow freely.
- Withdraw needle and observe patient for local anaesthetic toxicity (agitation, perioral tingling, tinnitus)
- Document procedure as per local policy. Ensure post-FIB observations (HR, BP, RR, oxygen saturations) are recorded immediately after the block, and 5/10/15/30 minutes following its administration.
References
- Figure 1 and additional reading on landmark and ultrasound guided fascia iliaca block can be found at: Range, C., & Egeler, C. (2010, August 23). Fascia Iliaca Compartment Block: LANDMARK AND ULTRASOUND APPROACH. ANAESTHESIA TUTORIAL OF THE WEEK. Retrieved September 28, 2025, from https://resources.wfsahq.org/wp-content/uploads/193_english-1.pdf
Written by Dr Amina Aslam (CTF)
