Fascia iliaca block (FIB)
A fascia iliaca block (FIB) is a high‑volume, low‑concentration fascial plane block used in the emergency department to provide analgesia for hip and proximal femoral fractures.
Injecting local anaesthetic beneath the fascia iliaca facilitates spread to the femoral nerve and lateral cutaneous nerve of the thigh, and may variably reach the obturator nerve. FIBs reduce opioid requirements and improve comfort for imaging and transfer, particularly in older or frail patients.
RCEM recommends FIB as part of ED hip/femoral fracture pathways and requires documented competency for clinicians performing the block. Ultrasound guidance is preferred where operators are trained (NICE IPG285).
Indications and contraindications
- Indications
- Acute pain from suspected or confirmed fractured neck of femur, intertrochanteric fracture, or proximal femoral shaft fracture.
- Analgesic adjunct to minimise systemic opioids in older or frail patients.
- Facilitation of positioning, imaging and transfer to definitive care as part of multimodal analgesia.
- Absolute contraindications
- Patient refusal or inability to consent.
- Known allergy to the chosen local anaesthetic (for example, bupivacaine or levobupivacaine).
- Local infection at the planned injection site.
- Important precautions / relative contraindications
- Major uncorrected coagulopathy - follow local policy and obtain anaesthetic/haematology input (RCEM: anticoagulation is not automatically prohibitive; local governance required).
- Recent ipsilateral vascular surgery altering anatomy, severe local swelling, or compartment syndrome.