Block It Like It’s Hot: Regional Anesthesia, Pain Medicine & POCUS S3:E5 "Somebody call 911! Nerve blocks in the ER Part II 🚑"
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Apr 15, 2025 In this thrilling finale, the hosts debate the best nerve blocks for hip fractures and shoulder dislocations. They explore the differences between fascia iliaca and femoral blocks, as well as strategies for rib fracture analgesia. Listeners will be intrigued by a case of a PENG block leading to spontaneous hip reduction. The conversation also covers the nuances of brachial plexus approaches and fascinating techniques for treating fractures and abscesses, making this an essential listen for anyone in emergency medicine!
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Fascia Iliaca As The Scalable Hip Block
- Use infra-inguinal fascia iliaca (FICB) as the ED go-to for most hip fractures because it’s simple and scalable for novice learners.
- Use ~30–35 mL total with 10 mL saline for hydrodissection, then anesthetic and saline to close the space.
Combine PENG With Cheeky Femoral For Comfort
- A PENG block spares motor function but doesn’t fully address quadriceps spasm which contributes to hip pain.
- Consider adding a small femoral block after PENG when mobility isn’t required that evening.
Prioritize Simple, Familiar Anatomy For Training
- Teach novices the infra-inguinal approach because the anatomy (nerve, artery, vein) is familiar and safer to learn.
- Prioritize blocks that maximize success with minimal complications for ED training programs.