Experience Summary

In this 360-degree video, observe the procedure of performing a fascia iliaca block for a patient with a right-sided fractured neck of femur.

Clinical Context

A fascia iliaca block (FIB) is a regional anaesthetic technique used to provide analgesia for hip and femoral shaft fractures, as well as for pre-operative and post-operative pain control in lower limb surgeries. It targets the femoral nerve, lateral cutaneous nerve of the thigh, and occasionally the obturator nerve by depositing local anaesthetic in the fascia iliaca compartment, a potential space deep to the fascia iliaca and superficial to the iliacus muscle.

The FIB is particularly useful in emergency and prehospital settings for elderly patients with hip fractures, as it offers effective pain relief while reducing opioid requirements and associated side effects such as delirium, respiratory depression, and nausea.

The landmark-based technique is a safe and simple method that does not require ultrasound guidance, making it well-suited to resource-limited or time-sensitive environments. However, care must still be taken to avoid complications, such as vascular puncture, local anaesthetic toxicity, or nerve injury.

Steps for Performing a Fascia Iliaca Block (Landmark Technique):

1. Preparation and Consent:
   • Obtain informed consent, explaining the benefits and risks including infection, bleeding, nerve damage, and local anaesthetic toxicity.
   • Ensure resuscitation equipment and intralipid are available.
   • Position the patient supine and expose the groin area on the affected side.
2. Anatomical Landmark Identification:
   • Identify the anterior superior iliac spine and the pubic tubercle.
   • Draw an imaginary line between these two points.
   • Mark a point 1 cm below the junction of the lateral third and medial two-thirds of this line — this is the needle insertion site.
3. Aseptic Technique and Anaesthesia:
   • Clean the skin with antiseptic solution and apply a sterile drape.
   • Infiltrate the skin with a small amount of local anaesthetic.
4. Needle Insertion and Technique:
   • Insert a blunt-tipped or short bevel needle perpendicular to the skin.
   • Advance slowly; two “pops” are typically felt as the needle passes through the fascia lata and then the fascia iliaca.
   • After the second pop, aspirate to ensure the needle is not in a vessel.
5. Injection:
   • Inject 30–40 mL of a long-acting local anaesthetic (e.g., 0.25–0.5% levobupivacaine or bupivacaine (maximum 2mg/kg) made up to the appropriate volume using water for injection) incrementally, aspirating every 5 mL.
6. Post-procedure Monitoring:
   • Observe for signs of local anaesthetic toxicity.
   • Assess for effectiveness of the block (improved analgesia, sensory changes).
   • Document the procedure and monitor for complications.

Learning Outcomes

1. Observe the procedure of performing a fascia iliaca block using landmark technique.
2. Understand the procedural steps of performing a fascia iliaca block using landmark technique..
3. Understand the equipment required to perform a fascia iliaca block using landmark technique..
4. Understand the key safety points in performing a fascia iliaca block using landmark technique.
5. Understand the dose and volume of anaesthetic required for a fascia iliaca block.

External Resources

• RCEM Best Practice Guideline - Fascia iliac block