@article{brownUltrasoundguidedNerveBlocks2026,
	title = {Ultrasound-guided nerve blocks: discharge guidelines},
	volume = {21},
	issn = {1828-0447, 1970-9366},
	shorttitle = {Ultrasound-guided nerve blocks},
	url = {https://link.springer.com/10.1007/s11739-025-04195-9},
	doi = {10.1007/s11739-025-04195-9},
	language = {en},
	number = {1},
	urldate = {2026-06-20},
	journal = {Internal and Emergency Medicine},
	author = {Brown, Joseph and Goldsmith, Andrew and Duggan, Nicole and Stone, Alexander and Nagdev, Arun},
	month = jan,
	year = {2026},
	pages = {311--314},
}

@article{brownDefiningUltrasoundGuidedNerve2026,
	title = {Defining {Ultrasound}‐{Guided} {Nerve} {Block} {Competency} for {Emergency} {Medicine}: {A} {Delphi}‐{Method} {Consensus} {Statement}},
	volume = {10},
	issn = {2472-5390, 2472-5390},
	shorttitle = {Defining {Ultrasound}‐{Guided} {Nerve} {Block} {Competency} for {Emergency} {Medicine}},
	url = {https://onlinelibrary.wiley.com/doi/10.1002/aet2.70207},
	doi = {10.1002/aet2.70207},
	abstract = {ABSTRACT
            
              Background
              Ultrasound‐guided nerve blocks (UGNBs) are increasingly incorporated into multi‐modal analgesia in the Emergency Department (ED). Despite their growing adoption, there is no consensus defining when an Emergency Medicine (EM) clinician is competent to perform UGNBs. Training methods, assessment approaches, and credentialing standards remain highly variable across institutions. The objective of this study was to define competency in UGNBs for EM physicians through a modified Delphi method that included national experts in EM and Anesthesia.
            
            
              Methods
              A comprehensive librarian‐assisted literature review informed the development of a 123‐item questionnaire covering four domains: defining competency, teaching methods, assessment methods, and ongoing professional practice evaluation. Twenty‐seven experts (23 EM, 4 anesthesiology) representing 24 institutions participated in two rounds of electronic voting and discussion. Consensus was defined a priori as 80\% agreement.
            
            
              Results
              All 27 panelists (100\%) completed both rounds. Of 123 items, 61 achieved consensus: 33 items related to defining competency, 14 to teaching methods, 8 to assessment methods, and 6 to ongoing professional practice evaluation related to UGNBs. There was significant debate regarding the minimum number of UGNBs to determine competency and whether UGNBs should be included as a core ultrasound privilege.
            
            
              Conclusion
              This multidisciplinary modified Delphi provides the first national consensus defining competency in UGNBs for both practicing and EM physicians in training. The 61 consensus items offer a structured framework for residency curricula, faculty development, clinical privileging, and quality assurance. These recommendations may help guide forthcoming ACGME requirements and support safe, effective integration of UGNBs into emergency medicine training.},
	language = {en},
	number = {3},
	urldate = {2026-06-17},
	journal = {AEM Education and Training},
	author = {Brown, Joseph R. and Le, Nhu‐Nguyen and De Schutter, Anna and Miller, Danielle and Riscinti, Matthew and Bailitz, John and Borad, Neil and Carnell, Jen and Diller, David and Dreyfus, Andrea and Duggan, Nicole and Farrow, Rob and Goldsmith, Andrew and Haidar, David and Huang, Rob and Hurley, Meghan and Kessler, Ross and Lin, Judy and Macias, Michael and Manson, William and Mirsch, Daniel and Nagdev, Arun and Pawa, Amit and Ramachandran, Anirudh and Riddell, Jeff and Stone, Alex and Stroud, Hilary and Sungar, William Gannon and Vlasica, Katherine and Zeccola, Daniel and Tucker, Ryan},
	month = jun,
	year = {2026},
	pages = {e70207},
}

ABSTRACT Background Ultrasound‐guided nerve blocks (UGNBs) are increasingly incorporated into multi‐modal analgesia in the Emergency Department (ED). Despite their growing adoption, there is no consensus defining when an Emergency Medicine (EM) clinician is competent to perform UGNBs. Training methods, assessment approaches, and credentialing standards remain highly variable across institutions. The objective of this study was to define competency in UGNBs for EM physicians through a modified Delphi method that included national experts in EM and Anesthesia. Methods A comprehensive librarian‐assisted literature review informed the development of a 123‐item questionnaire covering four domains: defining competency, teaching methods, assessment methods, and ongoing professional practice evaluation. Twenty‐seven experts (23 EM, 4 anesthesiology) representing 24 institutions participated in two rounds of electronic voting and discussion. Consensus was defined a priori as 80% agreement. Results All 27 panelists (100%) completed both rounds. Of 123 items, 61 achieved consensus: 33 items related to defining competency, 14 to teaching methods, 8 to assessment methods, and 6 to ongoing professional practice evaluation related to UGNBs. There was significant debate regarding the minimum number of UGNBs to determine competency and whether UGNBs should be included as a core ultrasound privilege. Conclusion This multidisciplinary modified Delphi provides the first national consensus defining competency in UGNBs for both practicing and EM physicians in training. The 61 consensus items offer a structured framework for residency curricula, faculty development, clinical privileging, and quality assurance. These recommendations may help guide forthcoming ACGME requirements and support safe, effective integration of UGNBs into emergency medicine training.

@article{brownHighUtilityUltrasoundGuidedNerve2025,
	title = {High-{Utility} {Ultrasound}-{Guided} {Nerve} {Blocks} for {Emergency} {Department} {Use}},
	volume = {79},
	issn = {07364679},
	url = {https://linkinghub.elsevier.com/retrieve/pii/S073646792500335X},
	doi = {10.1016/j.jemermed.2025.08.026},
	language = {en},
	urldate = {2026-06-20},
	journal = {The Journal of Emergency Medicine},
	author = {Brown, Joseph and Prats, Michael and Stroud, Hilary and Goldsmith, Andrew and Nagdev, Arun},
	month = dec,
	year = {2025},
	pages = {151--162},
}

@article{mirschJustFactsBrachial2024,
	title = {Just the facts: brachial plexus blocks for upper extremity injuries in the emergency department},
	volume = {26},
	issn = {1481-8043},
	shorttitle = {Just the facts},
	doi = {10.1007/s43678-023-00628-6},
	abstract = {Ultrasound-guided nerve blocks (UGNBs) are becoming a more common method for pain control in the emergency department. Specifically, brachial plexus blocks have shown promise for acute upper extremity injuries as well as an alternative to procedural sedation for glenohumeral reductions. Unfortunately, there is minimal discussion in the EM literature regarding phrenic nerve paralysis (a well-known complication from brachial plexus blocks). The anatomy of the brachial plexus, its relationship to the phrenic nerve, and why ultrasound-guided brachial plexus blocks can cause phrenic nerve paralysis and resultant respiratory impairment will be discussed. The focus on patient safety is paramount, and those with preexisting respiratory conditions, extremes of age or weight, spinal deformities, previous neck injuries, and anatomical variations are at greater risk. We put forth different block strategies for risk mitigation, including patient selection, volume and type of anesthetic, block location, postprocedural monitoring, and specific discharge instructions. Understanding the benefits and risks of UGNBs is critical for emergency physicians to provide effective pain control while ensuring optimal patient safety.},
	language = {eng},
	number = {4},
	journal = {CJEM},
	author = {Mirsch, Daniel and Jelic, Tomislav and Prats, Michael I. and Dreyfuss, Andrea and Yates, Evan and Kummer, Tobias and Stenberg, Bob and Vlasica, Katherine and Nagdev, Arun},
	month = apr,
	year = {2024},
	keywords = {Anesthetics, Local, Brachial Plexus Block, Emergency Service, Hospital, Humans, Pain, Paralysis, Ultrasonography, Interventional, Upper Extremity},
	pages = {228--231},
}

Ultrasound-guided nerve blocks (UGNBs) are becoming a more common method for pain control in the emergency department. Specifically, brachial plexus blocks have shown promise for acute upper extremity injuries as well as an alternative to procedural sedation for glenohumeral reductions. Unfortunately, there is minimal discussion in the EM literature regarding phrenic nerve paralysis (a well-known complication from brachial plexus blocks). The anatomy of the brachial plexus, its relationship to the phrenic nerve, and why ultrasound-guided brachial plexus blocks can cause phrenic nerve paralysis and resultant respiratory impairment will be discussed. The focus on patient safety is paramount, and those with preexisting respiratory conditions, extremes of age or weight, spinal deformities, previous neck injuries, and anatomical variations are at greater risk. We put forth different block strategies for risk mitigation, including patient selection, volume and type of anesthetic, block location, postprocedural monitoring, and specific discharge instructions. Understanding the benefits and risks of UGNBs is critical for emergency physicians to provide effective pain control while ensuring optimal patient safety.

@article{goldsmithUltrasoundguidedNerveBlocks2024,
	title = {Ultrasound-guided nerve blocks in emergency medicine practice: 2022 updates},
	volume = {78},
	issn = {1532-8171},
	shorttitle = {Ultrasound-guided nerve blocks in emergency medicine practice},
	doi = {10.1016/j.ajem.2023.12.043},
	abstract = {OBJECTIVES: In the Emergency Department (ED), ultrasound-guided nerve blocks (UGNBs) have become a cornerstone of multimodal pain regimens. We investigated current national practices of UGNBs across academic medical center EDs, and how these trends have changed over time.
METHODS: We conducted a cross-sectional electronic survey of academic EDs with ultrasound fellowships across the United States. Twenty-item questionnaires exploring UGNB practice patterns, training, and complications were distributed between November 2021-June 2022. Data was manually curated, and descriptive statistics were performed. The survey results were then compared to results from Amini et al. 2016 UGNB survey to identify trends.
RESULTS: The response rate was 80.5\% (87 of 108 programs). One hundred percent of responding programs perform UGNB at their institutions, with 29\% (95\% confidence interval (CI), 20\%-39\%) performing at least 5 blocks monthly. Forearm UGNB are most commonly performed (96\% of programs (95\% CI, 93\%-100\%)). Pain control for fractures is the most common indication (84\%; 95\% CI, 76\%-91\%). Eighty-five percent (95\% CI, 77\%-92\%) of programs report at least 80\% of UGNB performed are effective. Eighty-five percent (95\% CI, 66\%-85\%) of programs have had no reported complications from UGNB performed by emergency providers at their institution. The remaining 15\% (95\% CI, 8\%-23\%) report an average of 1 complication annually.
CONCLUSIONS: All programs participating in our study report performing UGNB in their ED, which is a 16\% increase over the last 5 years. UGNB's are currently performed safely and effectively in the ED, however practice improvements can still be made. Creating multi-disciplinary committees at local and national levels can standardize guidelines and practice policies to optimize patient safety and outcomes.},
	language = {eng},
	journal = {The American Journal of Emergency Medicine},
	author = {Goldsmith, Andrew J. and Brown, Joseph and Duggan, Nicole M. and Finkelberg, Tomer and Jowkar, Nick and Stegeman, Joseph and Riscinti, Matthew and Nagdev, Arun and Amini, Richard},
	month = apr,
	year = {2024},
	keywords = {Cross-Sectional Studies, Emergency Medicine, Emergency Service, Hospital, Humans, Nerve Block, Nerve blocks, Opioid, Pain, Procedure, Regional anesthesia, Ultrasonography, Ultrasonography, Interventional, Ultrasound, United States},
	pages = {112--119},
}

OBJECTIVES: In the Emergency Department (ED), ultrasound-guided nerve blocks (UGNBs) have become a cornerstone of multimodal pain regimens. We investigated current national practices of UGNBs across academic medical center EDs, and how these trends have changed over time. METHODS: We conducted a cross-sectional electronic survey of academic EDs with ultrasound fellowships across the United States. Twenty-item questionnaires exploring UGNB practice patterns, training, and complications were distributed between November 2021-June 2022. Data was manually curated, and descriptive statistics were performed. The survey results were then compared to results from Amini et al. 2016 UGNB survey to identify trends. RESULTS: The response rate was 80.5% (87 of 108 programs). One hundred percent of responding programs perform UGNB at their institutions, with 29% (95% confidence interval (CI), 20%-39%) performing at least 5 blocks monthly. Forearm UGNB are most commonly performed (96% of programs (95% CI, 93%-100%)). Pain control for fractures is the most common indication (84%; 95% CI, 76%-91%). Eighty-five percent (95% CI, 77%-92%) of programs report at least 80% of UGNB performed are effective. Eighty-five percent (95% CI, 66%-85%) of programs have had no reported complications from UGNB performed by emergency providers at their institution. The remaining 15% (95% CI, 8%-23%) report an average of 1 complication annually. CONCLUSIONS: All programs participating in our study report performing UGNB in their ED, which is a 16% increase over the last 5 years. UGNB's are currently performed safely and effectively in the ED, however practice improvements can still be made. Creating multi-disciplinary committees at local and national levels can standardize guidelines and practice policies to optimize patient safety and outcomes.

@article{goldsmithComplicationRatesUltrasonographyGuided2024,
	title = {Complication {Rates} {After} {Ultrasonography}-{Guided} {Nerve} {Blocks} {Performed} in the {Emergency} {Department}},
	volume = {7},
	issn = {2574-3805},
	url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2826105},
	doi = {10.1001/jamanetworkopen.2024.44742},
	abstract = {Importance
              Ultrasonography-guided nerve blocks (UGNBs) have become a core component of multimodal analgesia for acute pain management in the emergency department (ED). Despite their growing use, national adoption of UGNBs has been slow due to a lack of procedural safety in the ED.
            
            
              Objective
              To assess the complication rates and patient pain scores of UGNBs performed in the ED.
            
            
              Design, Setting, and Participants
              This cohort study included data from the National Ultrasound-Guided Nerve Block Registry, a retrospective multicenter observational registry encompassing procedures performed in 11 EDs in the US from January 1, 2022, to December 31, 2023, of adult patients who underwent a UGNB.
            
            
              Exposure
              UGNB encounters.
            
            
              Main Outcomes and Measures
              The primary outcome of this study was complication rates associated with ED-performed UGNBs recorded in the National Ultrasound-Guided Nerve Block Registry from January 1, 2022, to December 31, 2023. The secondary outcome was patient pain scores of ED-based UGNBs. Data for all adult patients who underwent an ED-based UGNB at each site were recorded. The volume of UGNB at each site, as well as procedural outcomes (including complications), were recorded. Data were analyzed using descriptive statistics of all variables.
            
            
              Results
              In total, 2735 UGNB encounters among adult patients (median age, 62 years [IQR, 41-77 years]; 51.6\% male) across 11 EDs nationwide were analyzed. Fascia iliaca blocks were the most commonly performed UGNBs (975 of 2742 blocks [35.6\%]). Complications occurred at a rate of 0.4\% (10 of 2735 blocks). One episode of local anesthetic systemic toxicity requiring an intralipid was reported. Overall, 1320 of 1864 patients (70.8\%) experienced 51\% to 100\% pain relief following UGNBs. Operator training level varied, although 1953 of 2733 procedures (71.5\%) were performed by resident physicians.
            
            
              Conclusions and Relevance
              The findings of this cohort study of 2735 UGNB encounters support the safety of UGNBs in ED settings and suggest an association with improvement in patient pain scores. Broader implementation of UGNBs in ED settings may have important implications as key elements of multimodal analgesia strategies to reduce opioid use and improve patient care.},
	language = {en},
	number = {11},
	urldate = {2026-06-20},
	journal = {JAMA Network Open},
	author = {Goldsmith, Andrew and Driver, Lachlan and Duggan, Nicole M. and Riscinti, Matthew and Martin, David and Heffler, Michael and Shokoohi, Hamid and Dreyfuss, Andrea and Sell, Jordan and Brown, Calvin and Fung, Christopher and Perice, Leland and Bennett, Daniel and Truong, Natalie and Jafry, S. Zan and Macias, Michael and Brown, Joseph and Nagdev, Arun},
	month = nov,
	year = {2024},
	pages = {e2444742},
}

Importance Ultrasonography-guided nerve blocks (UGNBs) have become a core component of multimodal analgesia for acute pain management in the emergency department (ED). Despite their growing use, national adoption of UGNBs has been slow due to a lack of procedural safety in the ED. Objective To assess the complication rates and patient pain scores of UGNBs performed in the ED. Design, Setting, and Participants This cohort study included data from the National Ultrasound-Guided Nerve Block Registry, a retrospective multicenter observational registry encompassing procedures performed in 11 EDs in the US from January 1, 2022, to December 31, 2023, of adult patients who underwent a UGNB. Exposure UGNB encounters. Main Outcomes and Measures The primary outcome of this study was complication rates associated with ED-performed UGNBs recorded in the National Ultrasound-Guided Nerve Block Registry from January 1, 2022, to December 31, 2023. The secondary outcome was patient pain scores of ED-based UGNBs. Data for all adult patients who underwent an ED-based UGNB at each site were recorded. The volume of UGNB at each site, as well as procedural outcomes (including complications), were recorded. Data were analyzed using descriptive statistics of all variables. Results In total, 2735 UGNB encounters among adult patients (median age, 62 years [IQR, 41-77 years]; 51.6% male) across 11 EDs nationwide were analyzed. Fascia iliaca blocks were the most commonly performed UGNBs (975 of 2742 blocks [35.6%]). Complications occurred at a rate of 0.4% (10 of 2735 blocks). One episode of local anesthetic systemic toxicity requiring an intralipid was reported. Overall, 1320 of 1864 patients (70.8%) experienced 51% to 100% pain relief following UGNBs. Operator training level varied, although 1953 of 2733 procedures (71.5%) were performed by resident physicians. Conclusions and Relevance The findings of this cohort study of 2735 UGNB encounters support the safety of UGNBs in ED settings and suggest an association with improvement in patient pain scores. Broader implementation of UGNBs in ED settings may have important implications as key elements of multimodal analgesia strategies to reduce opioid use and improve patient care.

@article{farrowiiImplementationUltrasoundguidedRegional2024,
	title = {Implementation of an ultrasound-guided regional anesthesia program in the emergency department of a community teaching hospital},
	volume = {83},
	url = {https://www.sciencedirect.com/science/article/pii/S0196064423013823},
	number = {6},
	urldate = {2025-09-30},
	journal = {Annals of Emergency Medicine},
	publisher = {Elsevier},
	author = {Farrow II, Robert A. and Shalaby, Michael and Newberry, Mark A. and De Oca, Roman Montes and Kinas, David and Farcy, David A. and Zitek, Tony},
	year = {2024},
	pages = {509--518},
}

@article{walshImplementingUltrasoundguidedNerve2023,
	title = {Implementing ultrasound-guided nerve blocks in the emergency department: {A} low-cost, low-fidelity training approach},
	volume = {7},
	issn = {2472-5390},
	shorttitle = {Implementing ultrasound-guided nerve blocks in the emergency department},
	doi = {10.1002/aet2.10912},
	abstract = {BACKGROUND: Managing acute pain is a common challenge in the emergency department (ED). Though widely used in perioperative settings, ED-based ultrasound-guided nerve blocks (UGNBs) have been slow to gain traction. Here, we develop a low-cost, low-fidelity, simulation-based training curriculum in UGNBs for emergency physicians to improve procedural competence and confidence.
METHODS: In this pre-/postintervention study, ED physicians were enrolled to participate in a 2-h, in-person simulation training session composed of a didactic session followed by rotation through stations using handmade pork-based UGNB models. Learner confidence with performing and supervising UGNBs as well as knowledge and procedural-based competence were assessed pre- and posttraining via electronic survey quizzes. One-way repeated-measures ANOVAs and pairwise comparisons were conducted. The numbers of nerve blocks performed clinically in the department pre- and postintervention were compared.
RESULTS: In total, 36 participants enrolled in training sessions, eight participants completed surveys at all three data collection time points. Of enrolled participants, 56\% were trainees, 39\% were faculty, 56\% were female, and 53\% self-identified as White. Knowledge and competency scores increased immediately postintervention (mean ± SD t0 score 66.9 ± 8.9 vs. t1 score 90.4 ± 11.7; p {\textless} 0.001), and decreased 3 months postintervention but remained elevated above baseline (t2 scores 77.2 ± 11.5, compared to t0; p = 0.03). Self-reported confidence in performing UGNBs increased posttraining (t0 5.0 ± 2.3 compared to t1 score 7.1 ± 1.5; p = 0.002) but decreased to baseline levels 3 months postintervention (t2 = 6.0 ± 1.9, compared to t0; p = 0.30).
CONCLUSIONS: A low-cost, low-fidelity simulation curriculum can improve ED provider procedural-based competence and confidence in performing UGNBs in the short term, with a trend toward sustained improvement in knowledge and confidence. Curriculum adjustments to achieve sustained improvement in confidence performing and supervising UGNBs long term are key to increased ED-based UGNB use.},
	language = {eng},
	number = {5},
	journal = {AEM education and training},
	author = {Walsh, Carrie D. and Ma, Irene W. Y. and Eyre, Andrew J. and Dashti, Munaa and Stegeman, Joseph and Dias, Roger D. and Nagdev, Arun and Goldsmith, Andrew J. and Duggan, Nicole M.},
	month = oct,
	year = {2023},
	keywords = {POCUS, models, nerve block, procedure, regional anesthesia, simulation, ultrasound},
	pages = {e10912},
}

BACKGROUND: Managing acute pain is a common challenge in the emergency department (ED). Though widely used in perioperative settings, ED-based ultrasound-guided nerve blocks (UGNBs) have been slow to gain traction. Here, we develop a low-cost, low-fidelity, simulation-based training curriculum in UGNBs for emergency physicians to improve procedural competence and confidence. METHODS: In this pre-/postintervention study, ED physicians were enrolled to participate in a 2-h, in-person simulation training session composed of a didactic session followed by rotation through stations using handmade pork-based UGNB models. Learner confidence with performing and supervising UGNBs as well as knowledge and procedural-based competence were assessed pre- and posttraining via electronic survey quizzes. One-way repeated-measures ANOVAs and pairwise comparisons were conducted. The numbers of nerve blocks performed clinically in the department pre- and postintervention were compared. RESULTS: In total, 36 participants enrolled in training sessions, eight participants completed surveys at all three data collection time points. Of enrolled participants, 56% were trainees, 39% were faculty, 56% were female, and 53% self-identified as White. Knowledge and competency scores increased immediately postintervention (mean ± SD t0 score 66.9 ± 8.9 vs. t1 score 90.4 ± 11.7; p \textless 0.001), and decreased 3 months postintervention but remained elevated above baseline (t2 scores 77.2 ± 11.5, compared to t0; p = 0.03). Self-reported confidence in performing UGNBs increased posttraining (t0 5.0 ± 2.3 compared to t1 score 7.1 ± 1.5; p = 0.002) but decreased to baseline levels 3 months postintervention (t2 = 6.0 ± 1.9, compared to t0; p = 0.30). CONCLUSIONS: A low-cost, low-fidelity simulation curriculum can improve ED provider procedural-based competence and confidence in performing UGNBs in the short term, with a trend toward sustained improvement in knowledge and confidence. Curriculum adjustments to achieve sustained improvement in confidence performing and supervising UGNBs long term are key to increased ED-based UGNB use.

@article{lentzDiaphragmaticExcursionNovel2022,
	title = {Diaphragmatic {Excursion} as a {Novel} {Objective} {Measure} of {Serratus} {Anterior} {Plane} {Block} {Efficacy}: {A} {Case} {Series}},
	volume = {6},
	issn = {2474-252X},
	shorttitle = {Diaphragmatic {Excursion} as a {Novel} {Objective} {Measure} of {Serratus} {Anterior} {Plane} {Block} {Efficacy}},
	doi = {10.5811/cpcem.2022.7.57457},
	abstract = {INTRODUCTION: Pain scales are often used in peripheral nerve block studies but are problematic due to their subjective nature. Ultrasound-measured diaphragmatic excursion is an easily learned technique that could provide a much-needed objective measure of pain control over time with serial measurements.
CASE SERIES: We describe three cases where diaphragmatic excursion was used as an objective measure of decreased pain and improved respiratory function after serratus anterior plane block in emergency department patients with anterior or lateral rib fractures.
CONCLUSION: Diaphragmatic excursion may be an ideal alternative to pain scores to evaluate serratus anterior plane block efficacy. More data will be needed to determine whether this technique can be applied to other ultrasound-guided nerve blocks.},
	language = {eng},
	number = {4},
	journal = {Clinical Practice and Cases in Emergency Medicine},
	author = {Lentz, Brian and Kharasch, Sigmund and Goldsmith, Andrew J. and Brown, Joseph and Duggan, Nicole M. and Nagdev, Arun},
	month = nov,
	year = {2022},
	pages = {276--279},
}

INTRODUCTION: Pain scales are often used in peripheral nerve block studies but are problematic due to their subjective nature. Ultrasound-measured diaphragmatic excursion is an easily learned technique that could provide a much-needed objective measure of pain control over time with serial measurements. CASE SERIES: We describe three cases where diaphragmatic excursion was used as an objective measure of decreased pain and improved respiratory function after serratus anterior plane block in emergency department patients with anterior or lateral rib fractures. CONCLUSION: Diaphragmatic excursion may be an ideal alternative to pain scores to evaluate serratus anterior plane block efficacy. More data will be needed to determine whether this technique can be applied to other ultrasound-guided nerve blocks.

@article{brownUltrasoundGuidedNerveBlocks2022,
	title = {Ultrasound-{Guided} {Nerve} {Blocks}: {Suggested} {Procedural} {Guidelines} for {Emergency} {Physicians}},
	volume = {7},
	issn = {2369-8543},
	shorttitle = {Ultrasound-{Guided} {Nerve} {Blocks}},
	doi = {10.24908/pocus.v7i2.15233},
	abstract = {Acute pain is one of the most frequent, and yet one of the most challenging, complaints physicians encounter in the emergency department (ED). Currently, opioids are one of several pain medications given for acute pain, but given the long-term side effects and potential for abuse, alternative pain regimens are sought. Ultrasound-guided nerve blocks (UGNB) can provide quick and sufficient pain control and therefore can be considered a component of a physician's multimodal pain plan in the ED. As UGNB are more widely implemented at the point of care, guidelines are needed to assist emergency providers to acquire the skill necessary to incorporate them into their acute pain management.},
	language = {eng},
	number = {2},
	journal = {POCUS journal},
	author = {Brown, Joseph R. and Goldsmith, Andrew J. and Lapietra, Alexis and Zeballos, Jose L. and Vlassakov, Kamen V. and Stone, Alexander B. and Knight, R. Starr and Carnell, Jennifer and Nagdev, Arun},
	year = {2022},
	keywords = {Opioids, Pain Management, Regional Anesthesia, Ultrasound Guided Nerve Blocks, Ultrasound Guided Procedures},
	pages = {253--261},
}

Acute pain is one of the most frequent, and yet one of the most challenging, complaints physicians encounter in the emergency department (ED). Currently, opioids are one of several pain medications given for acute pain, but given the long-term side effects and potential for abuse, alternative pain regimens are sought. Ultrasound-guided nerve blocks (UGNB) can provide quick and sufficient pain control and therefore can be considered a component of a physician's multimodal pain plan in the ED. As UGNB are more widely implemented at the point of care, guidelines are needed to assist emergency providers to acquire the skill necessary to incorporate them into their acute pain management.