Indications and Contraindications:

The most common indication for fascia iliaca block in the emergency department is for a fractured neck of femur. It is now considered a part of the standard of care for this patient cohort.

NICE recommends that paracetamol should routinely be prescribed for these patients, along with judicious use of opiates⁸. Nerve blocks should be considered as an adjunct if preoperative pain relief is inadequate, or if opiates need to be limited for clinical reasons. Nerve blocks should never be considered a substitute for early surgery.

Nerve blocks should be administered by trained personnel. This could include nurse practitioners or paramedics in addition to physician practitioners^9,10.

Absolute contraindications:

• Competent patient refusal
• Allergy to local anaesthetic
• Infection over the proposed injection site

Relative contra-indications

• Significant swelling around fracture site (risk of masking compartment syndrome)
• Previous femoral bypass surgery (due to post-operative adhesions limiting anaesthetic spread within fascial plane)
• Known peripheral neuropathy in the affected limb
• Recent failed block (repeat blockade could be considered by an alternative operator provided cumulative safe anaesthetic dosage is not exceeded)

Anticoagulation (this is no longer an absolute contraindication, and with training and ultrasound guidance, nerve blocks can be considered for all anticoagulated patients)¹¹.