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Related Concept Videos

Local Anesthetics: Differential Sensitivity of Nerve Fibers01:24

Local Anesthetics: Differential Sensitivity of Nerve Fibers

Local anesthetics (LAs) block the sodium channels of nerve trunks, sensory nerve endings, and neuromuscular junctions. Although LAs can block all kinds of nerves, the sensitivity of nerve fibers differs according to nerve types and structures. LAs are known to block myelinated fibers faster than unmyelinated ones. Also, they block pain or sensory neurons at low concentrations without affecting the motor neurons involved in muscle contractions. This helps relieve labor pain without affecting the...
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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
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Nondepolarizing neuromuscular blockers prevent the membrane depolarization of muscle cells and inhibit muscle contraction. These are usually administered with anesthetics to achieve complete muscle relaxation. Upon administration, these drugs first block the small, rapidly contracting muscles of the face and hands, followed by the larger muscles of the trunk and the intercostal muscles. The diaphragm is the last muscle to be affected.
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Related Experiment Video

Updated: Jun 9, 2026

Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
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Published on: January 31, 2025

Defining Ultrasound-Guided Nerve Block Competency for Emergency Medicine: A Delphi-Method Consensus Statement.

Joseph R Brown1, Nhu-Nguyen Le2, Anna De Schutter3

  • 1Department of Emergency Medicine University of Colorado Aurora Colorado USA.

AEM Education and Training
|June 8, 2026
PubMed
Summary
This summary is machine-generated.

Emergency Medicine physicians now have a national consensus on competency for Ultrasound-Guided Nerve Blocks (UGNBs). This framework standardizes training and credentialing for safe and effective patient care.

Keywords:
POCUSacute pain managementcompetencyemergency departmentmedical educationnerve blockregional analgesiaregional anesthesiaultrasound‐guided nerve blocks

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Area of Science:

  • Emergency Medicine
  • Anesthesiology
  • Medical Education

Background:

  • Ultrasound-guided nerve blocks (UGNBs) are increasingly used in Emergency Department (ED) multi-modal analgesia.
  • Current standards for Emergency Medicine (EM) clinician competency in UGNBs are variable.
  • There is a need to establish clear competency definitions and training guidelines.

Purpose of the Study:

  • To define competency standards for Emergency Medicine physicians performing UGNBs.
  • To establish a national consensus on UGNB competency through expert agreement.
  • To create a framework for UGNB training and credentialing in EM.

Main Methods:

  • A modified Delphi method was employed, involving national experts in EM and Anesthesiology.
  • A comprehensive literature review informed a 123-item questionnaire.
  • Twenty-seven experts participated in two rounds of electronic voting, with consensus defined as 80% agreement.

Main Results:

  • All 27 panelists completed both voting rounds.
  • 61 out of 123 items achieved consensus.
  • Consensus was reached on defining competency, teaching methods, assessment, and practice evaluation for UGNBs, with debate on minimum numbers and core privilege status.

Conclusions:

  • This study presents the first national consensus defining UGNB competency for EM physicians.
  • The 61 consensus items provide a framework for residency curricula, faculty development, and quality assurance.
  • These recommendations can guide ACGME requirements and support the integration of UGNBs into EM training.