Quick Reference Guide
Quick Reference Guide
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Step 2 · Quick Reference Guide
Ultrasound-guided fascia iliaca block
The key facts on one page.
| Topic | Key points | Source |
|---|---|---|
| Indication | Hip and proximal femoral fracture pain; part of multimodal analgesia, started as soon as possible | RCEM 2025; NICE CG124 |
| Contraindications | Refusal; LA allergy; INR above 1.5, platelets below 100, anticoagulants (relative); infection at site; previous femoral vascular surgery; cannot identify anatomy; cannot cooperate (relative) | RCEM 2025 |
| Anatomy | NAV lateral to medial. Nerve under the fascia iliaca; vessels above it. Targets: femoral nerve and lateral femoral cutaneous nerve | |
| Infra-inguinal | Probe transverse below the inguinal ligament; needle in plane lateral to medial; tip under the fascia iliaca, lateral third | |
| Supra-inguinal | Probe sagittal medial to the ASIS; bow-tie; needle caudal to cranial; fascia lifts and "unzips" | Hebbard 2011 |
| Dose (RCEM example) | Bupivacaine 0.25% (2.5 mg/mL); maximum 2 mg/kg. Over 50 kg: 40 mL; under 50 kg: 30 mL. Follow your local protocol | RCEM 2025 |
| Injection | Aspirate every 5 mL; inject slowly; watch spread; talk to the patient | RCEM 2025 |
| LAST | Stop, call for help, oxygen, treat seizures, CPR if needed; 20% lipid emulsion 1.5 mL/kg over 1 minute, then 15 mL/kg/h | QRH 3-10 |
| Monitoring | At least 1 hour: ECG, BP, SpO2, RR, GCS. Pain score before and at 30 minutes. Do not repeat a failed block | RCEM 2025 |
| Safety | Prep, Stop, Block before the needle. Wrong-site block is a Never Event. Falls precautions after the block | SALG/RA-UK 2022 |
Stop and get help
- Any doubt about the side
- You cannot see the fascia iliaca or the needle tip
- Blood on aspiration, pain on injection or high resistance
- Any symptom of local anaesthetic toxicity
Sources for this chapter
- Royal College of Emergency Medicine. Best Practice Guideline: Fascia Iliaca Block in the Emergency Department (first published March 2020, updated October 2025)
- National Institute for Health and Care Excellence. Hip fracture: management (CG124) (2011, last updated 2023), analgesia recommendations
- Hebbard P, Ivanusic J, Sha S. Ultrasound-guided supra-inguinal fascia iliaca block: a cadaveric evaluation of a novel approach. Anaesthesia 2011;66:300–305
- Association of Anaesthetists. Quick Reference Handbook 3-10: Local anaesthetic toxicity, version 2 (2023)
- Safe Anaesthesia Liaison Group and Regional Anaesthesia UK. Prep, Stop, Block: national standardised operating procedure to prevent wrong-side blocks (2022)
These notes support a simulation course. They do not replace your trust's regional anaesthesia and fascia iliaca block policy, the manufacturer's instructions for your equipment, or supervised workplace training and sign-off.
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