Take a Holistic Approach to Ultrasound-Guided Nerve Blocks
By Arun Nagdev, MD; David Martin, MD; Joe Stegeman, MD, MBA; Joe Brown, MD; and Andrew Goldsmith, MD, MBA
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on March 10, 2026
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It has been a privilege to write about point-of-care ultrasound (POCUS) for ACEP Now’s Sound Advice, and in particular to introduce and expand the conversation around ultrasound- guided regional analgesia for emergency clinicians. In my opinion, POCUS has become a critical imaging modality for all emergency physicians and continues to grow rapidly beyond the ED into nearly every area of medicine. As the field evolves, having new authors bring fresh perspectives on how we teach, apply, and integrate POCUS is essential to the continued growth of Sound Advice. POCUS is the future of medicine, and I look forward to reading the outstanding work ahead in the years to come.
Thanks,
Arun[/sidebar]
Implementing a holistic approach to nerve blocks does not require a complex protocol—it requires a mindset. Each block should be viewed as one pillar of a broader, patient-centered analgesic strategy. In practice, this means:
- Initiating multimodal analgesia early, before performing the UGNB
- Performing the block safely, with appropriate dosing and continuous ultrasound visualization
- Planning proactively for rebound pain, with a documented and communicated post-block regimen
As UGNBs become increasingly routine in emergency care, this approach can help standardize practice and improve pain outcomes for patients with acute injuries.
Summary: The Block Is Just the Beginning
Ultrasound-guided nerve blocks are among the most powerful tools available for acute pain management in the emergency department. However, procedural expertise alone is insufficient. Developing a comprehensive analgesic plan, from early systemic pain control to precise block performance to intentional post-block care, enhances both block efficacy and the patient experience. By thinking holistically about the lifecycle of a nerve block, we move beyond procedural success toward comprehensive, patient-centered pain care. The result is safer, more compassionate, and more durable analgesia for the patients we serve.
Dr. Nagdev is the Emergency Ultrasound Division Director, Alameda Health System – Highland Hospital.
Dr. Martin is the Emergency Ultrasound Fellowship Director, Alameda Health System – Highland Hospital.
Dr. Stegeman is the Community Ultrasound Director, Alameda Health System – Highland Hospital.
Dr. Brown is Associate Program Director at Denver Health Emergency Medicine and Education Director, Point-of-Care Ultrasound Group at the University of Colorado, Anschutz Medical Campus.
Dr. Goldsmith is Vice-Chair of the Department of Emergency Medicine at Lahey Hospital at the University of Massachusetts-Chan Lahey School of Medicine.
References
- Goldsmith AJ, Brown J, Duggan NM, et al. Ultrasound-guided nerve blocks in emergency medicine practice: 2022 updates. Am J Emerg Med. 2024;78:112-119.
- Lee JS, Chenkin J, Simard R, et al. Ultrasound-Guided Regional Anesthesia by Emergency Physicians for Hip Fractures and Delirium: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(12):e2549337.
- Chen J, Pan Z, Zheng J. Effect of Intravenous Esketamine on Rebound Pain Following Single-Shot Brachial Plexus Block in Patients Undergoing Shoulder Arthroscopic Surgery: A Prospective, Randomized, Placebo-Controlled Study. J Pain Res. 2025;Volume 18:5235-5248.
- Khan Z, Hameed M, Khan FA. Current role of perioperative intravenous ketamine: a narrative review. Anesthesiol Perioper Sci. 2023;1(4):36.
- Driver L, Perice L, Brown JR, Nagdev A, Goldsmith A. Ultrasound-guided nerve blocks: expert opinion statement on patient monitoring in the emergency department setting. Intern Emerg Med. 2025;20(8):2589-2591.
- Brown J, Goldsmith A, Duggan N, Stone A, Nagdev A. Ultrasound-guided nerve blocks: discharge guidelines. Intern Emerg Med. Published online November 14, 2025.
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