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Ultrasound-guided fascia iliaca blocks for hip fracture: is the juice worth the squeeze?
  1. David Metcalfe1,2,
  2. Alex Novak2,
  3. Immanuel Paul2,
  4. James S Bowness3,4
  1. 1 Oxford Trauma & Emergency Care (OxTEC), Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  2. 2 Emergency Medicine Research in Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  3. 3 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  4. 4 Department of Anaesthesia, Aneurin Bevan Health Board, Newport, UK
  1. Correspondence to Dr David Metcalfe, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 9DU, UK; david.metcalfe{at}

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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 …

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  • Handling editor Edward Carlton

  • X @TraumaDataDoc, @AlexTNovak, @bowness_james

  • Contributors DM drafted the article following discussions with AN, IP and JSB who all then made critical revisions to the manuscript. DM, AN, IP and JSB all approved the final version.

  • Funding This study was supported by the National Institute for Health and Care Research (NIHR Advanced Fellowship (ID302219)) and NIHR Oxford Biomedical Research Centre.

  • Competing interests DM and AN are members of the EMJ editorial board. JSB is a senior clinical advisor and has received research funding and honoraria from Intelligent Ultrasound, which develops assistive artificial intelligence systems for medical ultrasound including ultrasound-guided regional anaesthesia.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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