Fascia iliaca compartment block: a short how-to guide

The fascia iliaca compartment block (FICB) aims to provide anaesthesia and analgesia to the anterior compartment of the thigh, thereby providing analgesia for fractures to the femur and neck of femur, as well as potentially for soft-tissue injures to this area.

It does this by interrupting the conduction of nerve impulses by the femoral nerve and lateral cutaneous nerve of the thigh. An FICB does not provide analgesia or anaesthesia to the distal leg below the knee, which is supplied by the sciatic nerve, nor to the medial aspect of the thigh, which is supplied by the obturator nerve.

A short guide is presented to the landmark approach to FICB, and the choice of local anaesthetic volume to be given by patient's estimated weight.

FICB is a simple technique, and allows a high quality of analgesia to be given without the side effects of opiate analgesia. FICB is the current gold standard in the management of neck of femur fractures with pain unresponsive to intravenous opioids and paracetamol (National Institute for Health and Care Excellence (NICE), 2017). It is frequently performed in emergency departments, but has also been used as a prehospital intervention by nurses and paramedics, where it has been demonstrated to be both safe and effective (Hards et al, 2018), without reducing on-scene times (McRae et al, 2015).