Fascia Iliaca Block


Anatomical Target and Coverage
This fascial plane block aims to anesthetize femoral, obturator and lateral cutaneous nerves by injecting local anesthetic under Fascia Iliaca above the iliacus muscle. First described as a cadaveric study by Hebbard in 2011, the supra-inguinal approach allows a more cephalad injection of local anesthetic where the nerves originating in the lumbar plexus are closer in proximity and therefore providing a much higher likelihood of blocking all 3 nerves.¹

Performance of this block is fairly simple, and less painful with fewer complications compared to a lumbar plexus block which has a potential for neuraxial spread of injectate.²

As a fascial plane block, it provides analgesia to the hip, knee, and the thigh rather than surgical anesthesia. This procedure is often used to treat pain associated with hip fractures, as well as post- operative analgesia for corrective surgery for hip fractures³ , hip arthroplasty⁴, and hip arthroscopies as a post-operative rescue injection.⁵ A catheter technique can be used if prolonged analgesia is needed. Useful indications for catheters are for hip fracture patients as the catheter can be placed in the emergency depart or preoperatively and it can be used post operatively until the time of discharge.

Clinical Use: 

Block Technique

The block is performed in an in-plane approach with patient in a supine position with a high frequency linear probe. For obese patients, a lower frequency curvilinear probe can be used. The needle is introduced from caudad to cephalad under the fascia iliaca just superficial to the iliacus muscle and local anesthetic is injected.  If possible, the needle is advanced cephalad in plane to maximize cephalad spread.


  • Adult patients >60kg
  • Single shot: 40ml of 0.2% ropivacaine
  • Infusion: 8ml/hour 0.1-0.2% ropivacaine 

Block Duration

When performed with ropivacaine, the single shot block can last 6-12 hours. When longer block duration is required, a catheter-based technique can be used to prolong analgesia for days.

Special Considerations: 

Patient refusal, local anaesthetic allergy, infection at the site.

Relative contraindications are coagulopathy or anticoagulation.  In these settings, risk/benefit consideration must be assessed by the provider.

Side effects

  • Lower extremity weakness is a possibility despite the use of dilute solutions⁵


  • Infection, hematoma along the needle path likely in the muscles, local anesthetic systemic toxicity is extremely rare, nerve damage is also very unlikely as no nerves are visualized or targeted

Who do I contact if I feel my patient could benefit from a regional anesthesia technique?

When booking OR cases, surgeons can enter requests for regional anesthesia. The Department of Anesthesia schedules experienced providers to perform these blocks in all ORs. For regional anesthesia in inpatients reach out to the Acute Pain Service that covers your campus. 

Please see the link for the pain team consult service:


Hebbard P, Ivanusic J, Sha S. Ultrasound-guided supra-inguinal fascia iliaca block: a cadaveric evaluation of a novel approach. Anaesthesia. 2011;66(4):300-5.

Auroy Y, Benhamou D, Bargues L, et al. Major complications of regional anesthesia in France: The SOS regional anesthesia hotline service. Anesthesiology. 2002;97:1274-80.

Steenberg J, Moller AM. Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br J Anaesth. 2018 Jun;120(6):1368-1380.

Desmet M et al. A longitudinal Supra-Inguinal Fascia Iliaca Compartment Block Reduces Morphone Consumption After Total Hip Arthroplasty. Reg Anesth Pain Med.  2017 May/Jun;42(3):327-333.

Behrends M, Yap EN, Zhang AL, Kolodzie K, Kinjo S, Harbell MW, Aleshi P. Preoperative Fascia Ilica Block Does Not Improve Analgesia after Arthroscopic Hip Surgery, but Causes Quadriceps Muscles Weakness: A Randomized, Double-blind Trial. Anesthesiology. 2018 Sep;129(3):536-543.