Fascia iliaca block

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Published: September 2022

Each year, approximately 19,000 patients in Australia present with a new hip fracture.1 It is a common, debilitating injury, mostly occurring in people aged over 65 years old.2

A hip fracture is a break at the top of the thigh bone (femur) near the pelvis, usually as the result of a fall. The aim of treatment is to ease pain and restore mobility as soon as possible, usually through surgery.

Fascia iliaca block (FIB) is an injection given near the hip for people with fractured hip while waiting for surgery. It can ease pain for up to 12 hours and can reduce the need for opiates.

The use of FIB can reduce adverse outcomes, reduce the risk of delirium, reduce length of stay and improve both the patient experience and staff satisfaction.

    Resources

    • Fascia iliaca block guide - a guide to ultrasound-guided FIB utilising an out-of-plane approach. Tools and resources to enable the use of FIB as an analgesic option for patients with acute hip fracture and ensure patients with suspected or confirmed acute hip fracture are provided with safe and effective preoperative pain relief.
    • Fascia iliaca block toolkit - a toolkit to support the successful implementation of FIB in NSW health facilities having the appropriate governance. Includes competency, training, staffing, equipment, patient volume, infrastructure and supervision in place.
    • Frequently asked questions - a leaflet for patients and their carers about the benefits and risks of FIB.
    • Clinical competency assessment tool - the performance criteria for a clinician providing care to a patient requiring a FIB, with a place for the supervisor to record their assessment decision of the clinician’s performance.
    • Clinician’s logbook - to be completed by clinicians intending to be assessed in the insertion of fascia iliaca blocks.
    Please note that the out-of-plane approach has been selected because needle trajectory is parallel to the vascular bundle, rather than in the direction of the vessels, and allows easy conversion to a catheter technique. It is a safer approach for those training in ultrasound-guided FIB. The out-of-plane approach allows for easily viewable needle trajectory in the complimentary videos. These documents are to support ultrasound-guided FIB training and should be used complimentarily to clinical training and observation. We acknowledge there are a range of other options or techniques.

    Acknowledgements

    This project was a collaboration between the Agency for Clinical Innovation Pain Management and Aged Health Networks, and the St Vincent’s Health Network. First published in October 2015 and updated in September 2022.

    References

    1. Australian and New Zealand Hip Fracture Registry. Welcome to the Australian and New Zealand Hip Fracture Registry. ANZHFR; 2021 [cited 20 Sep 2022].
    2. Australian and New Zealand Hip Fracture Registry. The Patient Journey. ANZHFR; 2021 [cited 20 Sep 2022].
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