PNBschool

PNBschool specializes in providing onsite ultrasound guided peripheral nerve block training to practicing anesthesia personnel.

Our focus is on ultrasound guided techniques, current trends in postoperative pain relief and new technology.

04/15/2026

Re**us Sheath Block — underrated and highly effective.

This is one of the most consistent, easy-to-perform blocks for anterior abdominal wall analgesia. It targets somatic pain only—skin, muscle, and fascial layers—so don’t expect visceral coverage, but what it does cover, it covers reliably.

👉 Where it shines:
• Midline incisions
• Supra-umbilical coverage (where TAP starts to fall off)
• Clean supplementation to other abdominal blocks

👉 Why I use it:
• Can be performed quickly between intubation and incision
• Low technical difficulty
• Highly reproducible spread in the re**us sheath plane

👉 Best strategy: combine it
Pair this with a TAP block and you can achieve near-complete abdominal wall coverage:
• TAP → lateral abdominal wall
• Re**us sheath → midline + above T7 coverage

The TAP alone doesn’t reliably cover above T7 or the midline — this is exactly where the re**us sheath block fills the gap.

Bottom line:
Simple. Fast. Reliable.
Very underutilized for how effective it is.

⸻

Do you routinely add re**us sheath blocks to your abdominal cases, or relying on TAP alone?

04/14/2026

Multimodal analgesia doesn’t mean opioid avoidance.
It means using every tool appropriately.

Opiates are a mode of analgesia—and in many cases, a small, well-timed dose can make a meaningful difference. Smoother induction. Blunted sympathetic response. More comfortable wake-up. Better PACU experience.

There are absolutely times I’ll perform opioid-free anesthesia—but it’s the exception, not the rule. Usually patient-driven or in the setting of opioid use disorder. Otherwise, I’ve found that a little opioid early in the case often improves the overall flow for both the patient and the anesthetic.

But this is where finesse matters.

It’s not just what you give—it’s when you give it.

Take shoulder surgery—rotator cuff or total shoulder arthroplasty. With a solid interscalene block, I often don’t need opioids at all for analgesia. But I still need to manage the physiologic response to laryngoscopy and intubation.

That’s a temporary stimulus.

So instead of reaching for an opioid, I’ll use a well-timed dose of propofol just before intubation to blunt that response. Then move on.

Different problem → different solution.

That’s the point.

Multimodal doesn’t mean eliminating opioids.
It means being intentional with every medication you give.

A little thought. A little timing.
A little finesse goes a long way.

04/13/2026

Enhanced recovery doesn’t happen by accident — it happens by design.

Whether it’s TKA or any major orthopedic case, you should have a clear perioperative plan that gives your patient the best possible shot at recovery: less pain, less nausea, faster mobilization, shorter LOS, and higher satisfaction.

Most ERAS-style protocols end up looking similar:
• Multimodal premedication
• Thoughtful use of regional anesthesia (ACB + IPACK, etc.)
• Opioid-sparing strategies
• + a choice of spinal or general anesthesia

But the key point:
👉 There isn’t just one “right” way to do it — there are multiple ways to achieve the same outcome if you’re intentional about your approach.

Consistency > perfection.
A reproducible system beats improvisation every time.

What’s your go-to for TKA?
👉 General anesthesia or spinal?

04/12/2026

Total Hip Arthroplasty + Regional Anesthesia

We’ll often use a combination like a PENG block + LFCN block to target hip joint innervation while preserving motor function.

But honestly—what matters most isn’t just the block…

It’s the conversation you have with the patient.

⸻

This is exactly how I frame it:

I never tell patients
👉 “You’re not going to have any pain.”

Because that’s not real medicine—and patients know it.

Instead I tell them:

• “This is going to significantly reduce your pain.”
• “You’ll still have some discomfort, but it should be much more manageable.”
• “We are NOT withholding pain medication because you got a block.”
• “You’ll still get everything you need for comfort.”

And most importantly:

👉 “You’ll know the block worked when it wears off tomorrow.”

⸻

That last point is key.

Because when I follow up the next day,
patients almost always say:

➡️ “Yeah… it was definitely working.”

⸻

Regional anesthesia isn’t about eliminating pain.
It’s about:

✔️ Reducing opioid requirements
✔️ Improving early mobility
✔️ Smoother PACU recovery
✔️ Better overall experience

But the setting of patient expectations…

That’s what actually builds trust.

⸻

Good blocks matter.
Clear communication matters more.

⸻

Save this for your next hip case 🦴
Share with someone working on their block practice
Follow for more regional anesthesia content

04/11/2026

Regional anesthesia isn’t just a technique — it’s the backbone of modern ERAS pathways.

If you’re not leveraging regional in your ERAS protocols… you’re leaving outcomes on the table.

👉 Here’s what the data consistently shows:

• ↓ Postoperative pain
• ↓ Opioid consumption
• ↓ Nausea & vomiting
• ↓ PACU time
• ↓ Hospital length of stay
• ↓ Postoperative complications
• ↓ Infection rates (including pulmonary complications)
• ↓ 30-day readmissions (in many protocols)
• ↑ Early mobilization
• ↑ Functional recovery
• ↑ Patient satisfaction

ERAS programs built around multimodal + regional anesthesia have been shown to significantly reduce length of stay, pain scores, opioid use, and complications across multiple surgical specialties

And when you zoom out…

This is really about one thing:
👉 Changing the trajectory of recovery, not just treating pain.

⸻

💡 Clinical reality:
The difference between a patient struggling POD1 vs walking, eating, and discharging early…
is often your block selection and ex*****on.

⸻

📌 Save this.
📌 Share with your team.
📌 Follow for high-yield regional anesthesia content that actually changes practice.

⸻

UltrasoundGuided NerveBlocks PNBschool MedEd AnesthesiaLife FOAMed MedEducation

04/10/2026

Stop missing IVs.

Start out-of-plane to quickly identify the vessel, confirm compressibility, and center your target.

Then switch in-plane to track the needle tip the entire way in.

→ Better visualization
→ Better control
→ Better success

This hybrid approach is simple—but it changes everything.

Save this and try it on your next difficult IV.

04/09/2026

Re**us sheath block — simple, reliable midline analgesia.

Great for umbilical and midline incisions, but remember: this is a targeted block, not complete abdominal wall coverage on its own.

🔑 Pro tip:
Combine re**us sheath blocks + TAP blocks for broader coverage.
Even better — perform them immediately subcostal to extend cephalad spread and achieve near-complete anterior abdominal wall analgesia.

Save this for your next abdominal case.

04/08/2026

Be honest — what’s your default?

Phenylephrine or ephedrine?

Most people pick based on habit.
The best clinicians pick based on physiology.

This is the framework that actually matters ⬆️

👇 Drop your go-to below
💾 Save this for your next case
📤 Share with your anesthesia group
➕ Follow PNBschool | Regional Anesthesia Education — we make regional & anesthesia simple

04/07/2026

Most people pick their local anesthetic out of habit… not strategy.

But here’s the truth 👇

Ropivacaine and bupivacaine both deliver excellent regional anesthesia — the difference is how they fail, how long they last, and who they’re safest for.

🔹 Need a safer profile with less cardiac/CNS toxicity? → Ropi
🔹 Need longer, denser analgesia for bigger cases? → Bupi

That choice matters more than most people think — especially when you’re balancing block quality vs. patient risk.

The best clinicians aren’t just placing blocks… they’re choosing drugs intentionally.

What’s your go-to — and why?

04/06/2026

Most people are missing THIS step in ultrasound-guided IV placement…

If you’re struggling with small veins or inconsistent success, your approach might be the problem—not your skill.

This is my go-to technique:

• Start out-of-plane → track the needle tip precisely into the vessel
• Confirm flash in the catheter hub → you’re in
• Then rotate in-plane → visualize and guide the needle further within the vein
• Advance with confidence → thread the catheter smoothly

This hybrid approach gives you maximum information at every step—and is a game changer for accessing smaller or deeper veins.

It’s not about guessing.
It’s about seeing everything.

Save this for your next difficult IV—and share it with someone who needs this technique.

Follow for more high-yield anesthesia content.

04/03/2026

A quick update: I have still never used Vasopressin🤷🏻‍♂️

Vasopressin remains one of the most targeted tools for vasoplegic, catecholamine-resistant hypotension.
Pure V₁ effect, minimal chronotropy, and useful when norepinephrine isn’t enough — especially in RAAS blockade or post-CPB physiology.

Please share in the comments, when is Vasopressin your drug of choice? How often do you use it? What dose do you use? Please share this post with anyone who uses it Vasopressin.

04/02/2026

Hypotension is the most common problem we manage in the OR—yet treatment often becomes reflexive.

Choosing the right vasopressor should be guided by physiology, not habit. Heart rate, vascular tone, cardiac output, and anesthetic depth all matter when deciding what to give and when to escalate.

Treat the cause first, then match the drug to the physiology.

Address

18697 Bagley Road
Middleburg Heights, OH
44130

Website

http://PNBschool.com/

Alerts

Be the first to know and let us send you an email when PNBschool posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.

Contact The Practice

Send a message to PNBschool:

Shortcuts

Want your practice to be the top-listed Clinic in Middleburg Heights?