• fractures
• anaesthesia
• analgesia

Hip fractures require prompt, effective analgesia. However, there is evidence from national audits in the UK that pain is often managed ineffectively in this population.1

The fascia iliaca compartment block (FIB) provides targeted analgesia without the systemic risks of opioids and non-steroidal anti-inflammatories.2 In this technique, a large volume of long-acting local anaesthetic (such as 40 mL 0.25% bupivacaine) is deposited beneath the fascia iliaca where it spreads along the fascial plane to variably anaesthetise the femoral, lateral femoral cutaneous and obturator nerves.3 Preoperative FIB for hip fractures is associated with reduced pain, opioid use, delirium and mortality.2 3 As FIB can be undertaken safely by generalist clinicians,4 it is now an established part of ED hip fracture management. Most UK emergency physicians have learnt to perform FIBs using a landmark technique,5 whereby the fascial plane is identified by advancing a blunt needle through the skin and feeling two distinct ‘pops’ as the fascia lata and fascia iliaca are breached.

In their EMJ paper, Ghazali et al present a new tool for assessing the technical skill of performing an ultrasound-guided FIB.6 This reflects …