Basic Nerve Block Principles

Learning Objectives:

  1. Perform procedural guidance in both transverse and longitudinal approaches (when appropriate) for regional anesthesia

  2. Identify relevant US anatomy for each particular procedure/block

  3. Recognize relevant findings & pitfalls

  4. Integrate US for regional anesthesia into individual patient and departmental management


Indications:

  • Regional anesthesia for multimodal analgesia

Views:

  • Needle-in-plane clip of your needle in the correct anatomic location

  • Clip of your saline/anesthetic hydrodissecting the correct fascial plane

How to Scan:

ACEP Sonoguide:Ultrasound Guided Nerve Blocks

Core Ultrasound: Nerve Blocks

Highland Ultrasound

Tips/Tricks/Pitfalls:

  • Recommend in-plane technique for nerve blocks as you want to visualize surrounding structures and the entire needle (including the tip) during the procedure

  • Flush some saline through your needle while getting set up. Otherwise when you get your needle tip in the perfect spot and start injecting, the first thing that will enter the patient is AIR, which will obscure your beautiful US view!

  • It can sometimes be difficult to differentiate between nerve and tendon for peripheral blocks. Track your tendon proximally until it turns into muscle to confirm your structures.

  • Calculate the maximum dose of any local anesthetic you’re using - check out this helpful table on Highland US website

  • LAST (Local Anesthetic Systemic Toxicity): when a large volume of local anesthetic reaches the systemic circulation and causes toxicity -> can lead to central nervous system and/or cardiovascular collapse

    • When performing large volume nerve blocks, be sure to have your patient on the cardiac monitor and call pharmacy to ensure intralipid is available

Nerve Block Examples:

COMING SOON!

Full Text Literature:

  1. Lee et al. Assessing PA students ability to identify regional landmarks of the fascia iliaca after a brief training session

  2. Situ-La Casse et al. Performance of Ultrasound-guided Peripheral Nerve Blocks by Medical Students After One-day Training Session

  3. Ketelaars et al. Emergency physician-performed ultrasound-guided nerve blocks in proximal femoral fractures provide safe and effective pain relief: a prospective observational study in The Netherlands

Additional Resources:

Malin and Dawson iBook Volume 2

  • Chapter 5: Femoral Nerve Block

  • Chapter 6: Peripheral Nerve Blocks

The POCUS Atlas- Nerve Block Atlas

AEUS Lecture Introduction to Ultrasound Guided Nerve Blocks Rock the Block by Michael Heffler

NYSORA Topics

NYSORA Techniques

Author: Susan Mari, MD (Class of 2026)

Reviewed by: Christine Jung, MD-FPD