PNBschool

Directions Website Contact the business

PNBschool The leading Independent anesthesia education platform.

Focused on regional anesthesia, ultrasound-guided nerve blocks, pharmacology, perioperative medicine, board review, and CME education through a modern mobile-first learning platform.

10/21/2026

One of the most underused blocks available, and the easiest!

The LFCN is a pure sensory nerve sitting superficial, just lateral to the sartorius. It covers the lateral thigh skin, right where the hip incision lives. Great hip block but the incision still hurts? This is the piece you’re missing.

📲 FREE in the PNBschool Mobile app:
✅ 16 regional block modules
✅ Question of the Day pushed to your phone
✅ 3 pharmacology + 3 coexisting disease modules
✅ Spinal simulation
🔓 Unlock 1,500+ board review questions, over 70 pharmacology modules, 60+ coexisting disease modules, central line + epidural simulations, and up to 10 hours of CME
👉 Link in bio · App Store & Google Play

How to do it:
1. Find it superficial, just lateral to the sartorius
2. Needle in-plane, lateral to medial, shallow angle
3. Surround the branch with local
4. Branched nerve? Find the second branch and cover it too
5. Go proximal. Too distal can miss the posterior branch

PENG alone doesn’t cover the skin incision for a total hip. PENG + LFCN = motor-sparing hip analgesia and early walking.

Are you adding the LFCN to your hip blocks?

10/20/2026

The 4 questions everyone asked me at ASA 2026, answered in 30 seconds.

I spent the meeting scanning live in the FUJIFILM Sonosite, Inc. booth. The same four topics kept coming up: adductor canal vs. femoral triangle, re**us sheath + TAP, adding iPACK to a femoral triangle for TKA, and the proximal LFCN block for total hips.

Most people never see this side of Sonosite. They don’t sell you a machine and walk away. They stay with you:

🔹 Hundreds of hands-on workshops every year that pair theory with live scanning
🔹 The Sonosite Institute: on-demand POCUS modules and an image and video library for every customer
🔹 Clinical specialists who know you by first name and are still there long after the in-service
🔹 Online webinars on regional anesthesia and POCUS, led by clinicians who scan every day
🔹 Equipment support for regional anesthesia courses, so educators teach on real systems and not slides

Education. Support. Reliability. Unparalleled.

Thank you, Sonosite, for investing in anesthesia education everywhere.

Which of the 4 would you have asked? Tell me below 👇

10/20/2026

New-onset afib under anesthesia? Your first question is stable or unstable. If the pressure isn’t responding, the ECG shows ischemia, or the patient is in acute heart failure, go straight to synchronized cardioversion at 200 J or more with SYNC on.

Keep building your skills between cases with the PNBschool Mobile app:
• 𝟭𝟲 𝗿𝗲𝗴𝗶𝗼𝗻𝗮𝗹 𝗯𝗹𝗼𝗰𝗸 𝗺𝗼𝗱𝘂𝗹𝗲𝘀 (𝗙𝗥𝗘𝗘)
• 𝗤𝘂𝗲𝘀𝘁𝗶𝗼𝗻 𝗼𝗳 𝘁𝗵𝗲 𝗗𝗮𝘆 𝗽𝘂𝘀𝗵𝗲𝗱 𝘁𝗼 𝘆𝗼𝘂𝗿 𝗽𝗵𝗼𝗻𝗲 (𝗙𝗥𝗘𝗘)
• 𝗦𝗽𝗶𝗻𝗮𝗹 𝘀𝗶𝗺𝘂𝗹𝗮𝘁𝗶𝗼𝗻 (𝗙𝗥𝗘𝗘)
• 𝗘𝗽𝗶𝗱𝘂𝗿𝗮𝗹 𝗮𝗻𝗱 𝗰𝗲𝗻𝘁𝗿𝗮𝗹 𝗹𝗶𝗻𝗲 𝘀𝗶𝗺𝘂𝗹𝗮𝘁𝗶𝗼𝗻𝘀
• 𝗢𝘃𝗲𝗿 𝟳𝟬 𝗽𝗵𝗮𝗿𝗺𝗮𝗰𝗼𝗹𝗼𝗴𝘆 𝗺𝗼𝗱𝘂𝗹𝗲𝘀
• 𝟲𝟬+ 𝗰𝗼𝗲𝘅𝗶𝘀𝘁𝗶𝗻𝗴 𝗱𝗶𝘀𝗲𝗮𝘀𝗲 𝗺𝗼𝗱𝘂𝗹𝗲𝘀
• 𝟭,𝟱𝟬𝟬+ 𝗯𝗼𝗮𝗿𝗱 𝗿𝗲𝘃𝗶𝗲𝘄 𝗾𝘂𝗲𝘀𝘁𝗶𝗼𝗻𝘀
• 𝗨𝗽 𝘁𝗼 𝟭𝟬 𝗵𝗼𝘂𝗿𝘀 𝗼𝗳 𝗖𝗠𝗘

Download it FREE today. Tap the link in our bio or search PNBschool on the App Store or Google Play.

Stable? Work it in order:
1. Support the pressure.
2. Find the trigger: K+/Mg2+, volume, too light, hypoxia or hypercarbia, catecholamines, a wire or line in the atrium, ischemia, sepsis, PE, thyroid.
3. Control the rate: esmolol, metoprolol, diltiazem (avoid with reduced EF) or amiodarone (choice with low EF or heart failure). Goal: rate under ~110 and a stable pressure.

Very fast, wide, bizarre QRS? Think pre-excitation (WPW). No AV nodal blockers. Call cardiology.

Get cardiology involved if you cardioverted, it’s still afib in PACU, the EF is reduced, you suspect WPW, or anticoagulation needs deciding. Clot risk climbs after 48 hours. Perioperative afib is not just a blip.

Save this for your next case and send it to someone you work with in the OR.

10/19/2026

Where you inject the ESP decides what you cover.
T5 → chest wall: rib fractures and thoracic surgery.
L4 → lumbar spine surgery, sometimes hip.

𝗞𝗲𝗲𝗽 𝗹𝗲𝗮𝗿𝗻𝗶𝗻𝗴 𝗶𝗻 𝘁𝗵𝗲 𝗣𝗡𝗕𝘀𝗰𝗵𝗼𝗼𝗹 𝗠𝗼𝗯𝗶𝗹𝗲 𝗮𝗽𝗽. 𝗟𝗶𝗻𝗸 𝗶𝗻 𝗯𝗶𝗼, 𝗼𝗻 𝘁𝗵𝗲 𝗔𝗽𝗽 𝗦𝘁𝗼𝗿𝗲 𝗮𝗻𝗱 𝗚𝗼𝗼𝗴𝗹𝗲 𝗣𝗹𝗮𝘆.
𝗙𝗥𝗘𝗘: 𝟭𝟲 𝗿𝗲𝗴𝗶𝗼𝗻𝗮𝗹 𝗯𝗹𝗼𝗰𝗸 𝗺𝗼𝗱𝘂𝗹𝗲𝘀, 𝗤𝘂𝗲𝘀𝘁𝗶𝗼𝗻 𝗼𝗳 𝘁𝗵𝗲 𝗗𝗮𝘆 𝗽𝘂𝘀𝗵𝗲𝗱 𝘁𝗼 𝘆𝗼𝘂𝗿 𝗽𝗵𝗼𝗻𝗲, 𝘀𝗽𝗶𝗻𝗮𝗹 𝘀𝗶𝗺𝘂𝗹𝗮𝘁𝗶𝗼𝗻, 𝟯 𝗽𝗵𝗮𝗿𝗺𝗮𝗰𝗼𝗹𝗼𝗴𝘆 + 𝟯 𝗰𝗼𝗲𝘅𝗶𝘀𝘁𝗶𝗻𝗴 𝗱𝗶𝘀𝗲𝗮𝘀𝗲 𝗺𝗼𝗱𝘂𝗹𝗲𝘀
𝗨𝗻𝗹𝗼𝗰𝗸: 𝟭,𝟱𝟬𝟬+ 𝗯𝗼𝗮𝗿𝗱 𝗿𝗲𝘃𝗶𝗲𝘄 𝗾𝘂𝗲𝘀𝘁𝗶𝗼𝗻𝘀, 𝗼𝘃𝗲𝗿 𝟳𝟬 𝗽𝗵𝗮𝗿𝗺𝗮𝗰𝗼𝗹𝗼𝗴𝘆 𝗺𝗼𝗱𝘂𝗹𝗲𝘀, 𝟲𝟬+ 𝗰𝗼𝗲𝘅𝗶𝘀𝘁𝗶𝗻𝗴 𝗱𝗶𝘀𝗲𝗮𝘀𝗲 𝗺𝗼𝗱𝘂𝗹𝗲𝘀, 𝗰𝗲𝗻𝘁𝗿𝗮𝗹 𝗹𝗶𝗻𝗲 + 𝗲𝗽𝗶𝗱𝘂𝗿𝗮𝗹 𝘀𝗶𝗺𝘂𝗹𝗮𝘁𝗶𝗼𝗻𝘀, 𝘂𝗽 𝘁𝗼 𝟭𝟬 𝗵𝗼𝘂𝗿𝘀 𝗼𝗳 𝗖𝗠𝗘

What’s reliable: the back. Local spreads about 9 levels along the plane.
What’s not: the front. Spread toward the paravertebral space is inconsistent (J Clin Anesth 2023, systematic review).

Same plane every time. Coverage still varies by patient.

Send this to the person who thinks the ESP covers everything.

10/18/2026

QL1 in 3 steps: scan, slide, inject. If you can find the transversus abdominis, you can find this block.

Inside the PNBschool Mobile app:
- 16 regional block modules (free)
- Question of the Day pushed to your phone (free)
- Spinal, epidural and central line simulations
- Over 70 pharmacology modules
- 60+ coexisting disease modules
- 1,500+ board review questions
- Up to 10 hours of CME
Download free. Link in bio. App Store and Google Play.

1. Scan: patient supine, probe transverse on the flank just below the ribs. Identify external oblique, internal oblique and transversus abdominis.
2. Slide: move posterior until the transversus abdominis tapers into its aponeurosis and the quadratus lumborum comes into view.
3. Inject: in-plane, anterior to posterior, deep to the aponeurosis at the lateral border of the QL. 20 to 30 mL is typical. Color Doppler first, and dose by weight.

Save this for your next QL1.

10/17/2026

Interscalene block patients still having pain? Look at the biceps. Any surgery involving the biceps needs C7, and missing C7 is the most common reason this block “fails.”

Inside the PNBschool Mobile app:
- 16 regional block modules (free)
- Question of the Day pushed to your phone (free)
- Spinal, epidural and central line simulations
- Over 70 pharmacology modules
- 60+ coexisting disease modules
- 1,500+ board review questions
- Up to 10 hours of CME
Download free. Link in bio. App Store and Google Play.

Here is the trap: many providers think they have C7 in view, but what they are actually seeing is a split C6. C7 sits below and deeper. Scan caudal and confirm it before you inject.

If the surgeon surprises you with biceps work and you did not get C7, ask them to inject local at the surgical site. Simple fix, comfortable patient.

Do you routinely add C7 for shoulder cases? Tell us in the comments.

10/16/2026

Blocking only the saphenous? You’re leaving part of the knee on the table.

At the femoral triangle, go in-plane, lateral to medial. The nerve to vastus medialis is your first, lateral target. Put local around it on its own, then redirect and give the saphenous nerve a separate injection.

📲 Keep learning in the PNBschool Mobile app
FREE for everyone:
✅ Question of the Day pushed to your phone
✅ 16 regional block modules
✅ 3 pharmacology + 3 coexisting disease modules
✅ Spinal simulation
Unlock with CME:
🔸 1,500+ board review questions
🔸 Over 70 pharmacology modules
🔸 60+ coexisting disease modules
🔸 Central line + epidural simulations
🔸 Up to 10 hrs AMA PRA Category 1 Credit™ or ANCC contact hours
👉 Download free. Tap the link in bio. App Store + Google Play

Why bother with the NVM? It sends branches to the knee joint. If you only block the saphenous, you miss them. Two targets give better knee coverage than one.

Do you block the NVM separately, or count on spread? Tell me below.

Save this for your next knee case.

Heading to ASA 2026 in San Diego and I’d love to meet anyone who’s going! Stop by Booth 1435, October 17–19, and come sc...
10/15/2026

Heading to ASA 2026 in San Diego and I’d love to meet anyone who’s going!

Stop by Booth 1435, October 17–19, and come scan with us. We’ll be doing live scanning on a real patient and showing off the new Sonosite iLOOK, the latest and greatest in ultrasound for vascular access.

Bring your questions on nerve blocks, needle visibility, probe handling, or anatomy. Let’s talk shop.

See you at the San Diego Convention Center! Tag a colleague who’s going 👇

10/15/2026

It’s not anxiety. Perioral numbness, a metallic taste, or ringing ears mid-injection are early signs of local anesthetic systemic toxicity (LAST). Up to half of cases skip these warnings, and heavy sedation can silence the rest, so the first sign may be a seizure or a wide QRS.

Learn more in the PNBschool Mobile app. Link in bio, App Store + Google Play:
• 16 regional block modules (FREE)
• Question of the Day, pushed to your phone (FREE)
• Spinal simulation (FREE)
• Epidural + central line simulations
• Over 70 pharmacology modules
• 60+ coexisting disease modules
• 1,500+ board review questions
• Up to 10 hours of CME

First signs? Act now:
1. Stop injecting. Call for help, get the lipid kit
2. 100% O2 and ventilate. Hypoxia and acidosis make it worse
3. Seizure: benzodiazepine. Avoid big propofol doses if unstable
4. 20% lipid EARLY. Don’t wait for arrest
Over 70 kg: 100 mL bolus over 2–3 min, then 200–250 mL over 15–20 min
70 kg or less: 1.5 mL/kg bolus, then 0.25 mL/kg/min
Still unstable? Re-bolus once or twice, double the infusion. Upper limit about 12 mL/kg
5. Modified ACLS: epi under 1 mcg/kg. No vasopressin, CCBs, beta-blockers or more local
6. Expect a long resuscitation. Consider ECMO/bypass. Monitor 4–6 hours after
Prevent it: aspirate, inject 3–5 mL at a time, and watch for spread on every injection. No spread = STOP. Keep them talking.
Do you know where your lipid kit is today? 👇

10/14/2026

PENG covers the joint. It does NOT cover the skin. 🎯
That’s why a hip can still hurt after a “perfect” PENG — the incision lives on the lateral thigh, and that’s LFCN territory. Pair them and you get joint + skin, with both blocks sparing the quads.

👇 Want every block broken down like this?
Download the PNBschool Mobile app FREE — link in bio 📲
Available on the App Store + Google Play

FREE for everyone:
✅ Question of the Day pushed to your phone
✅ 16 regional block modules (PENG + LFCN included)
✅ 3 pharmacology + 3 coexisting disease modules
✅ Spinal simulation

Unlock with CME:
🔸 1,500+ board review questions
🔸 Over 70 pharmacology modules
🔸 60+ coexisting disease modules
🔸 Central line + epidural simulations
🔸 Up to 10 hrs AMA PRA Category 1 Credit™ or ANCC contact hours

The breakdown:
1️⃣ PENG = the joint. Deep to the psoas tendon, on bone. Covers the capsule, not the skin. Stays motor sparing when you inject away from the femoral nerve, in the right plane, with the right volume.
2️⃣ LFCN = the skin. Pure sensory. Block it proximally to catch both the anterior and posterior branches — that covers anterior AND posterolateral incisions.

📚 PENG + LFCN is being tested head-to-head vs fascia iliaca, QL, and wound infiltration for total hips. Protocols and outcomes vary — read the trials.

Stop chasing hip pain with more volume. Download free → link in bio. 📲

💬 Is PENG + LFCN your total hip combo, or are you running something else? Drop it below 👇

Address

18697 Bagley Road
Middleburg Heights, OH
44130

Website

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 Business

Send a message to PNBschool:

Shortcuts

Share

Category