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New RA-UK statement about FICB and non-physician practitioners

Fascia Iliaca blocks and non-physician practitioners

Thursday 23 January 2020

Early administration of a fascia iliaca block is recommended in patients with fractured neck of femur to reduce pain and use of opioid analgesia.1

Since the last joint statement from Regional Anaesthesia-UK (RA-UK) and the Association of Anaesthetists in 2013,2the use and availability of ultrasound for performance of the fascia iliaca block has increased.This has also led to the development of several ultrasound guided approaches to the fascia iliaca block which are more reliable than the traditional landmark approach.

The ultrasound guided infra-inguinal approach to the fascia iliaca block uses a similar needle insertion point to the landmark approach, distant from neurovascular structures. This approach allows visual confirmation of local anaesthetic spread in the correct anatomical plane, deep to the fascia iliaca.3

Physicians are often not immediately available to perform ultrasound guided fascia iliaca blocks at the time of patient arrival to hospital. In order to provide timely access to this beneficial treatment, RA-UK endorses the use of the infra-inguinal ultrasound guided fascia iliaca block by trained non-physician practitioners.This practice must be in the setting of appropriate local training programmes, with strict adherence to clinical governance protocols and regular review of quality and safety.

All patients should receive appropriate monitoring for 30 minutes after administration of a fascia iliaca block to detect signs of local anaesthetic toxicity, and also opioid induced respiratory depression in the setting of previously administered opioid analgesia. 4,5

We do not endorse the use of the suprainguinal fascia iliaca block by non-physician practitioners due to a higher potential risk of complications including intra-abdominal injury.6

References

  1. Scottish Government. Scottish standards of care for patients with hip fracture, 2018. https://www.shfa.scot.nhs.uk/_docs/2018/Scottish-standards-of-care-for-hip-fracture-patients-2018.pdf (accessed 26/09/19)
  2. Association of Anaesthetists and Regional Anaesthesia-UK. Fascia iliaca blocks and non-physician practitioners, 2013. https://www.ra-uk.org/images/Documents/Fascia_Iliaca_statement_22JAN2013.pdf (accessed 26/09/19)
  3. Dolan J, Williams A, Murney E, Smith M, Kenny GN. Ultrasound guided fascia iliaca block: a comparison with the loss of resistance technique. Regional Anesthesia and Pain Medicine 2008; 33: 526-31.
  4. Checketts MR, Alladi R, Ferguson K et al. Association of Anaesthetists of Great Britain and Ireland. Recommendations for standards of monitoring during anaesthesia and recovery 2015. Anaesthesia 2016; 71: 85-93.
  5. Royal College of Emergency Medicine. The importance of monitoring after fascia iliaca block (FIB), 2018. http://www.rcem.ac.uk/docs/Safety%20Resources%20+%20Guidance/RCEM_Fascia%20Iliaca%20Block_Safety%20Newsflash%20Feb%20(22022018)%20revised.pdf (accessed 26/09/19)
  6. Desmet M, Vermeylen K, Van Herreweghe I et al. A longitudinal supra-inguinal fascia iliaca compartment block reduces morphine consumption after total hip arthroplasty. Regional Anesthesia and Pain Medicine 2017; 42: 327-33.

This statement can be downloaded in full from our guidelines section