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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionBackground and Aims Effective pain management is crucial for patients with lower limb trauma in the remote Scottish Highlands, where long transport times to hospital are common. The Highland Pre-Hospital Immediate Care and Trauma (PICT) Team is trained to place lower limb nerve blocks (LLNBs) at the scene of injury, enabling earlier and more effective analgesia. This review assessed the safety and effectiveness of pre-hospital LLNBs performed by PICT from 2019 to 2023.Methods During this period, a total of 96 patients received LLNBs. Data collected included block type, use of ultrasound, documentation of pain scores, and complications.Results Of the 96 LLNBs, 72 were fascia-iliaca blocks (FIBs), 19 were femoral nerve blocks, and in 5 cases the block placed was unclear. Ultrasound guidance was utilised in 17 cases, a landmark approach employed in 16 cases, and documentation was incomplete in the remaining 63 cases. Pain score documentation varied widely: pre-LLNB, 6 patients had quantitative scores and 17 qualitative scores documented; post-LLNB, 2 had quantitative scores and 36 qualitative scores documented. No adverse events were reported.Abstract P156 Table 1PICT data collection tool - lower limb blocksData Tool Developed for Lower Limb BlocksConclusions Whilst LLNBs are seen as a safe technique, documentation quality was inconsistent, limiting the ability to assess their clinical effectiveness in managing pain from lower limb trauma. From this review a standardised document for LLNBs has been developed (see table 1), based on local and national best practices, aiming to improve data capture and support future service evaluations.