# Precision Relief: Nerve Blocks for Pain in Older Patients

About This Podcast

In today’s episode host Dr. Christina Shenvi is joined by Dr. Robert Sternberg, Ultrasound Director at Akron General, to discuss ultrasound-guided nerve blocks for precise pain relief in older patients. Ultrasound-guided nerve blocks provide relief from one of the most common emergency department complaints: pain. In addition to their use in acute pain management, nerve blocks can help reduce the use of opioids, reduce hospital length of stay, and improve patient outcomes and experiences. 

Using case examples, Dr. Sternberg talks through how to perform 4 common types of nerve blocks you may use in the emergency department with an elderly patient: Fascia Iliaca Compartment Block (FICB), Pericapsular Nerve Group (PENG) Block, Serratus Anterior Plane (SAP) Block and Erector Spinae Block (ESB). 

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Tune in to hear indications, dosing, key anatomical landmarks, and techniques for each of the nerve blocks. 

https://youtu.be/oXRrpQwa7BQ

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Key Points

The goal of a nerve block is to soak the nerve, not poke the nerve.

Dosing calculators, such as the SafeLocal app, are helpful tools when determining anaesthetic dose.

Nerve blocks can help reduce opiate prescribing in alignment with the CMS Age-Friendly Hospital Measure: Responsible Medication Management.

Be aware of local anaesthetic systemic toxicity (LAST).

Rare but serious complication caused by anaesthetic injection into a blood vessel.Can have a non-specific presentation: paraesthesia, dysrhythmia, vomiting, vertigo, seizures, cardiac arrest. 

Guidelines for treatment with lipid emulsion therapy should be in place.

Advise patients that the anaesthesia can take up to 30 minutes to kick in and monitor patients during this period for LAST.

Communicate with the inpatient team, especially in regard to a patients level of mobility.

Nerve Block Guides

The following are outstanding one-pager resources created by Dr. Brian Makowski that will guide you through each type of nerve block. Each one pager contains pictures, instructions, and links to additional videos and resources.

Fascia Iliaca Compartment Block (FICB)

2025

Download pdf

Pericapsular Nerve Group Block (PENG)

2025

Download pdf

Serratus Anterior Plane (SAP) Block

2025

Download pdf

Erector Spinae Block (ESB)

2025

Download pdf

Next, listen to Getting ED Specific with Medication Safety with Dr. Rachel Skains.

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