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

Read more: New RA-UK statement about FICB and non-physician practitioners

Election 2020 and news

After our annual board meeting yesterday, we are happy to announce that we have 2 new board members: Maria Sebastian and Jonathan Womack. We also welcome back Ashwani Gupta for a second term, and have a new trainee representative, Dr Toby Ashken.

In other changes, firstly, we say a fond farewell to Dr Morne Wolmarans, possibly the longest serving, and certainly one of our very best board members. He will continue to look after our UK RA interests within ESRA, and we expect to see him at the new improved Covid free ASM next year. We also say goodbye to our trainee rep Jim Parry, who, having gained a substantive post at Stanmore last year, is now replaced by Toby. We thank him for his hard work on the board, and again, will catch up soon at the many meetings and courses up and down the country. Finally, we give great thanks to Tim Moll who was coopted onto council for the last year to organise the ASM in Sheffield 2020. His hard work will not be in vain, however, as we have a special announcement soon about RA-UK 2021.

Secondly, we have a few position changes, Lloyd Turbitt has become our new treasurer, as Alan Macfarlane was unanimously voted our new president elect. He will take up his term of office when Amit Pawa steps down in 2021. Nat Haslam continues as honorary secretary, and we intend to co-opt Simeon West as webmaster/comms (to be ratified at the next AGM).

And finally, in view of our ASM in Sheffield unfortunately being cancelled, we have elected to run our Annual General Meeting virtually. This will be at 7:30 on the evening of 26th May. It will be held as a Zoom meeting (surprise, surprise). Any ordinary member who wishes to join, please send an email to This email address is being protected from spambots. You need JavaScript enabled to view it., and we will send you the secure link. 

A call for RA/ERAS protocols

Dear all,

At RA-UK 2019 I noticed that one of the most photographed slides of the conference was Dr Sandy Kopps' ERAS protocol for knees, which gave me a thought....

Why not host as many regional anaesthesia and enhanced recovery protocols as you'd like to share?

In time I hope this will become a valuable resource where people can see what others are doing, learn from and be inspired by different ways of doing things, as well as just plain not reinventing the wheel each time. We are interested in hearing from institutions around the world for their contributions.

If you have a protocol you're proud of, please send it to This email address is being protected from spambots. You need JavaScript enabled to view it., and we will upload to the site. Please send in word or pdf, but ensure it has your institutional affiliations.

RA-UK will provide these on the basis that they do not encompass societal recommendations of care, but rather a learning resource.

Plan A Blocks

PLan A AWe are pleased to announce a new section of the website entitled Plan A blocks.
A recent editorial by Turbitt et al in Anaesthesia highlighted the inconsistencies in education and training of anaesthetists to perform basic level regional blocks, and hypothesised that the explosion of new techniques facilitated by ultrasound had compounded the problem by intimidating the normal practitioner. They drafted a list of seven Plan A blocks that cover the key areas of surgery/acute pain, and suggested that every anaesthetist should be proficient in these, leaving the expert RA practitioner to help provide blocks for more complex circumstances. The text of the editorial is provided.
At RA-UK we believe in the widespread adoption of regional anaesthetic techniques for all, and it is our mission to improve patient care by promoting excellence in RA practice and education. 
We endorse the 7 Plan A blocks suggested, and have made available a new educational resource based on our popular Pocket Guide to Regional Anaesthesia - Second Edition. We will continue to update this section should new evidence arise to suggest other blocks fit the brief of “highest possible value to the greatest number of patients”. We hope that this can be used to teach and train the next generation of anaesthetists so that no-one comes out of training with an inability to provide this standard.
Regional experts will, of course, continue to provide the wide range of blocks as they see fit, and continue to research and push the boundaries of analgesia, and we fully support that endeavour.
You will find in this section on the right, detailed descriptions of each block taken from our pocket guide, which you will recieve for joining RA-UK. You can also download high resolution posters for printing, and watch our recent webinar on the Plan A blocks.

RCEM clarifies statement about FICB

Dear Members,

A recent statement by the RCEM about a tragic death after hip fracture generated a great deal of concern both amongst members and anaesthetic societies. 

We are pleased to report that the RCEM have taken steps to clarify their initial response, the text of which is provided below. RA-UK fully endorses the following.


22nd February 2018

We have been asked to reply to several recent queries regarding the Royal College of Emergency Medicine’s recent FIB safety newsflash published on 9th February 2018.

Firstly, thanks to those of you who have engaged and expressed an opinion on this matter. The safety newsflash has certainly generated lots of interest.

Most of the queries we received were from people who felt the headlines ‘death after fascia iliaca block’ and ‘stop before you block’ were misleading. This was not our intention. When we design these safety alerts, we aim to be punchy and bold in our headlines thus capturing the attention of our members.

Sometimes we do not always get this right and, in this instance, perhaps the headline ‘the importance of monitoring after fascia iliaca block’ would have been clearer.

Above all and most importantly we aim to highlight the risks that arise from such cases, ensuring that healthcare professionals are aware of the risks and that appropriate guidelines are put in place preventing future deaths.

The matters of concern as identified from the Coroner’s report to remember are as follows:

1) The Expert Consultant in Pain Medicine explained that after the fascia iliaca block was administered analgesia will occur over 10-15 minutes. As the patient obtains better analgesia from the fascia iliaca block, the opioids in the circulation would have more toxic effect than an analgesic effect. Pain is a potential arousal stimulus keeping the patient awake and aware of their surroundings. Pain is also a respiratory stimulant. There is an intimate link between the neurophysiology of pain and the respiratory stimulant. It was recognised that removing a painful stimulus using a local anaesthetic block can pre-dispose patients who have had opioids to respiratory depression. The risk can be increased if the patient has other respiratory depressant risks such as alcohol which can act synergistically with the opioid. In order to avoid this, the patient would need to be observed during the first 30 minutes after the administration of the block to reverse the effect of the opioid or support the respiration if required to avoid a cardiac arrest and death.

  1. 2)  At the time of death there were no National Guidelines to advise on the need to monitor patients post procedure or application of the anaesthetic nerve block.
  2. 3)  At inquest it was clear from the evidence of the Clinical Director of Emergency Medicine that in 2015 the effect of relative opioid toxicity following the administration of a local anaesthetic nerve block for proximal femur fractures was not widely recognised within emergency medicine. As there was an increase in the use of fascia iliaca block in conjunction with opioid analgesia in emergency medicine, the risk should be highlighted to health professionals so that they were aware of the risk and the appropriate guidelines put in place.

At RCEM, it is our responsibility to increase the awareness of such risks so that the appropriate preventative measures, guidance and protocols can be put in place by healthcare professionals. In this case, to reduce the risk of respiratory depression, arrest or death after the administration of fascia iliaca block.

The Royal College of Emergency Medicine recommends the following measures and guidance:

An ED LocSSIP / guideline should include documentation of:

  • Site, side, dose and time of block
  • Frequency of past procedure observations: a minimum would be at 5, 10, 15, 30 mins post procedure • RCEM/FIBguideline Finally, the fact that this safety newsflash has generated so much interest can only be viewed as a positive as it is from open and transparent conversations that we are able to further our learning and improve patient care. Please feel free to circulate this reply to whosoever in your Trust you consider appropriate.


Best wishes,

The Royal College of Emergency Medicine


Pocket Guide to Regional Anaesthesia now available

We are delighted to announce that the shiny, brand new second edition of the RA-UK Pocket Guide to Regional Anaesthesia is now available to purchase from Amazon.

Those waiting on copies promised for membership should now have been received, (if you think you are due a book and havent received one, please contact the membership helpdesk on This email address is being protected from spambots. You need JavaScript enabled to view it.). We have plenty of stock for bulk orders for courses etc.

Thanks for your patience, and we hope you like the new book!