Fascia Iliaca

by | Aug 24, 2021


  • Fractures of the femoral head, neck, intertrochanteric/subtrochanteric regions, shaft
  • Proximal tibial fractures
  • Patella fractures
  • Anterior thigh lacerations or abscesses


  • Infection overlying injection site
  • Allergy to local anesthetic
  • Request of consultant
  • Concern for compartment syndrome


  • 20-40cc of local anesthetic of choice
  • 18-22G needle
  • Saline Flush
  • Cleansing solution
  • Ultrasound with high-frequency linear transducer
  • Ultrasound transducer sterile cover



Position the patient supine



  1. Place the transducer in a transverse orientation just inferior to the inguinal crease, in the medial third of the inguinal crease
  2. Identify the femoral artery with the nerve just lateral to it
  3. Laterally, identify the iliacus muscle, with the sartorius muscle superior to this

The probe marker is to the lateral aspect of the patient. The femoral nerve (N) is seen lateral to the femoral artery (A), and the sartorius muscle (S) is seen superficial to the iliacus muscle (I), with the fascia iliaca in between the two muscles. The target site for injection is just deep to the fascia iliaca, at a point lateral to the femoral nerve (*). Anesthetic should be visualized tracking medially toward the femoral nerve.

  1. The fascial plane between these muscles which surrounds the femoral nerve is the fascia iliaca


  1. Introduce needle lateral to medial
  2. In-plane needle visualization
  3. After puncturing through fascia iliaca, infiltrate a small volume of the anesthetic solution to see the fascia lift up off of the nerve
  4. Infuse remaining local anesthetic
  5. Confirm by visualizing an expanding anechoic collection just below the fascia iliaca


Needle entering from the lateral aspect (screen right) and depositing anesthetic just deep to the fascia iliaca (*) which lies deep to the sartorius muscle and superficial to the iliacus muscle.



  1. The POCUS Atlas
  2. WikEM