Nerve blocks are very familiar to Emergency Physicians. Ultrasound guidance allows more precise delivery of anesthetic to nerves, and compartments to provide field anesthesia. The nerve block initiative is aimed at improving analgesia and minimizing complications of parenteral medications for patients with acute hip fracture. This is especially important in the elderly patient at elevated risk of hemodynamic compromise, respiratory depression and delirium. The blocks which address this need are the fascia Iliaca block, the femoral nerve block and the PENG block. The Emergency Medicine Service Line has published guidelines regarding use of these blocks for our hip fracture patients.
For the provider starting to learn or expanding their use, there is an excellent iOS application available, AnSo Pro (Anesthesia Sonoanatomy). The app has detailed instructions for a variety of blocks as well as 2D ultrasound images detailing the anatomy. In addition, the Emergency Medicine Residents Association (EMRA) has a free regional anesthesia app available in the apple store. If you are looking for a comprehensive nerve block course. The best EM course is blockheads. They run several courses a year and usually one before the ACEP scientific assembly.
A rare complication of the delivery of the larger volumes of anesthetic used for these blocks is LAST or Local Anesthetic Systemic Toxicity. Fortunately, theree is specific treatment for this, lipid emulsion therapy (commercially known as Intralipid).