PNBschool

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.

06/23/2026

Most TAP blocks don’t fail… they’re just being asked to do a job they weren’t designed to do.

If your patient still has pain around the umbilicus after a “successful” TAP block, the issue may not be the block—it may be your decision on what blocks to perform.

🔹 TAP blocks are great for lateral abdominal wall analgesia.
🔹 Re**us sheath blocks are often needed for midline and peri-umbilical port sites.
🔹 Many laparoscopic procedures involve BOTH areas, making a TAP + Re**us Sheath combination a powerful option.

Understanding incision location is just as important as understanding block anatomy.

What’s your go-to block strategy for laparoscopic abdominal surgery or any abdominal surgery? TAP alone, Re**us Sheath alone, both, QL or ESP? Let me know in the comments. 👇

📲 Download the PNBschool Anesthesia & Blocks App:
✅ 16 FREE nerve block modules
✅ Ultrasound anatomy guides
✅ Probe & needle placement instruction
✅ Labeled block videos
✅ 1,500+ board-review questions
✅ 60+ pharmacology modules
✅ 60+ coexisting disease modules
✅ Up to 10 hours of CME

**usSheathBlock

06/22/2026

Your ultrasound machine is probably not the problem.

Most clinicians spend too much time adjusting depth, frequency, and probe position while completely ignoring one of the simplest image optimization tools: GAIN.

A quick rule of thumb:

Blood vessels should be the darkest structures on the screen.

If your vessels look gray instead of black, your gain is probably too high. If everything looks too dark and anatomy disappears, your gain is probably too low.

A few clicks can completely change image quality and make needle visualization and anatomy identification much easier.

What’s your best tip for optimizing an ultrasound image?

Drop it in the comments. Let’s see what tricks everyone is using.

06/20/2026

STOP CALLING EVERYTHING AN ADDUCTOR CANAL BLOCK.

The adductor canal block has become the default answer for knee analgesia—but that doesn’t automatically make it the best answer.

A true adductor canal block performed distally may miss important articular branches that contribute to knee pain. Moving proximally into the femoral triangle can provide coverage of additional sensory targets while still preserving much of the quadriceps function that made the adductor canal block popular in the first place.

Does that mean the femoral triangle block is always better? No.

But if your patients are consistently waking up with more pain than expected after total knee arthroplasty, it may be time to look at where you’re injecting—not just what you’re calling the block.

👇 Tell me in the comments:

ADDUCTOR CANAL BLOCK or FEMORAL TRIANGLE BLOCK?

What are you using for TKA and why?

📱 Want to master regional anesthesia?

The PNBSchool: Anesthesia & Blocks app includes:

✅ 16 FREE nerve block modules
• Correct probe positioning
• Needle placement guidance
• Ultrasound anatomy
• Fully labeled procedural videos
• Clinical pearls and technique tips

🧠 Board Review System
• 1,500+ board-style questions
• Detailed answer explanations
• Practice and Exam Modes
• Track progress across 39 subject areas

🎓 Up to 10 hours of CME annually
• AMA PRA Category 1 Credits™
• ANCC Nursing Continuing Education available through our accredited CME partner

💊 60+ Pharmacology Modules
• Drugs you actually use in anesthesia
• Mechanisms, dosing, side effects, and clinical considerations

❤️ 60+ Coexisting Disease Modules
• From aortic stenosis to thrombocytopenia
• Practical perioperative management
• Point-of-care reference when you need it

Built by anesthesia professionals. Used by thousands of anesthesia clinicians.

📲 Download PNBSchool: Anesthesia & Blocks on the App Store or Google Play.

06/19/2026

🌎 WHERE IN THE WORLD AM I? 🌎

If you recognized every medication in this video before the labels appeared… you’re probably right where I am.

Regional anesthesia, cardiac anesthesia, pediatrics, trauma, office-based anesthesia... every subspecialty has its own drug preferences and workflow. But OB anesthesia is its own world entirely. Different physiology, different priorities, different medications, and a completely different set of challenges.

On any given day you’re balancing maternal safety, fetal considerations, labor analgesia, surgical anesthesia, hemodynamics, urgency, and patient expectations—all while working in one of the most dynamic environments in anesthesia.

Some anesthesia providers love OB. Others avoid it like the plague. But whether it’s your favorite assignment or your least favorite call shift, it’s hard to argue that it does require a unique skill set.

💬 Let’s see who’s really paying attention...

👇 How many of these medications have you personally used?

👇 What medication gave away the answer immediately?

👇 Do you enjoy OB anesthesia, tolerate it, or avoid it altogether?

👇 TAP Blocks, QL or nothing for csections?

Anesthesiologist? CRNA? CAA? SRNA? Student? Drop your role and location in the comments.

Let’s compare practice patterns from around the world.

06/18/2026

The blood pressure cuff may be the most painful part of your anesthetic. Said no one ever!😅

Tag your anesthesia provider and give them a hug today… they’ve been dealing with this complaint since the invention of the NIBP cuff. 😂

All jokes aside, this reel is a parody. Patient comfort matters, but sometimes the solution is a little more effective than repositioning the cuff.

📱 Download the PNBschool: Anesthesia & Blocks app and level up your anesthesia knowledge.
The LINK IS IN OUR BIO.

✅ 16 FREE regional anesthesia block modules
✅ 1,500+ board review questions
✅ Practice & Exam Modes
✅ Progress tracking
✅ 60+ pharmacology modules
✅ 60+ coexisting disease modules
✅ Up to 10 AMA PRA Category 1 Credits™ / ANCC Nursing CEs annually
✅ Available on iPhone & Android

Learn something new. Review for boards. Earn CME. Improve your practice.

06/17/2026

“Your adductor canal block didn’t work...”

Or did it?

One of the biggest mistakes we make in regional anesthesia isn’t the block itself—it’s failing to set the right expectations.

The adductor canal block is an excellent motor-sparing analgesic block for knee surgery, but it does not provide complete anesthesia to the entire knee. Many patients will still experience discomfort when they first wake up in PACU, especially around the anterior knee and surgical incision.

That doesn’t mean the block failed.

In fact, many patients report their pain is much better controlled by the time they reach the floor—or are ready for same-day discharge. Every minute the patient gets from the initial incision it seems their analgesia improves.

The goal of a nerve block isn’t necessarily zero pain.

The goal is to:
✅ Reduce overall pain
✅ Decrease opioid requirements
✅ Minimize nausea and vomiting
✅ Preserve quadriceps strength
✅ Improve mobility and recovery

Most patients understand and appreciate these benefits when they’re explained appropriately before surgery.

But if we promise complete pain relief and the patient wakes up with any discomfort at all, satisfaction drops—even when the block is doing exactly what it was designed to do.

Successful regional anesthesia starts with successful expectation management.

📲 Want to learn more about adductor canal blocks and regional anesthesia? Download the PNBschool: Anesthesia & Blocks mobile app. Access 16 FREE regional anesthesia modules, 1,500+ board review questions, pharmacology content, coexisting disease modules, CME opportunities, and more.

06/16/2026

Yes, I said it, bigger is not better😳:

3 LMA for women. 4 LMA for men.

That simple rule works surprisingly well for me. Tell me why I’m wrong in the comments.

For those learning airway management, here are a few LMA basics worth knowing:

An LMA (laryngeal mask airway) is a supraglottic airway, meaning it sits above the vocal cords rather than passing through them like an endotracheal tube.

✅ Fast to place
✅ Less stimulating than intubation
✅ Excellent for many ambulatory and short-duration procedures
✅ Can be used with spontaneous ventilation or positive-pressure ventilation

You don’t have to leave patients breathing spontaneously. Many anesthesia providers ventilate through an LMA using pressure support, pressure control, or volume-targeted modes depending on the patient and procedure.

When patients are breathing spontaneously, opioids can be titrated to respiratory rate very effectively.

Just remember:

❌ An LMA is not a definitive airway
❌ It does not fully protect against aspiration
❌ Avoid it in patients with a full stomach, active reflux, bowel obstruction, gastroparesis, pregnancy beyond appropriate fasting guidelines, or other situations where aspiration risk is elevated

A few placement tips:

• Fully deflate and smooth the cuff before insertion
• Use adequate lubrication on the posterior surface only
• Insert with a firm, continuous motion following the hard palate
• Confirm placement with chest rise, capnography, tidal volumes, and minimal leak pressure

There are multiple insertion techniques—standard digital insertion, introducer-guided placement, rotational techniques, and partially inflated cuff techniques. The “best” method is usually the one that gives you a fast, atraumatic first-pass success rate.

Now let’s hear it...

3 for women and 4 for men. Agree or disagree?

06/15/2026

🚨 QUESTION OF THE WEEK 🚨

Think you know the answer?

Drop your choice in the comments and tell us why. The correct answer will be revealed in our Instagram Story tomorrow.

⛔ No looking it up.
⛔ No changing your answer after reading the comments.

The PNBschool Anesthesia & Blocks Mobile App was built by anesthesia professionals, for anesthesia professionals.

Inside the app:

✅ 1,500+ Board Review Questions
✅ Practice & Exam Modes
✅ Detailed Explanations and Rationales
✅ Performance Tracking & Mistake Review
✅ Daily Question of the Day
✅ 16 FREE Regional Anesthesia Modules
✅ 60+ Pharmacology Modules
✅ 60+ Coexisting Disease Modules
✅ Up to 10 AMA PRA Category 1 Credits™ or ANCC Nursing CEs

Whether you’re preparing for boards, earning CME, learning regional anesthesia, or staying sharp between cases, PNBschool puts everything you need in your pocket.

📲 Download the PNBschool Anesthesia & Blocks Mobile App on the App Store or Google Play and see why thousands of anesthesia professionals use it every day.

👇 Drop your answer below in the comments.

06/13/2026

🚨 ANESTHESIA APOCALYPSE 🚨

You can only keep TWO.

The other THREE disappear forever.

No substitutions.
No workarounds.
No “I’ll just use something else.”

Pick 2:

💉 Dexmedetomidine
💉 Ketamine
💉 Lidocaine
💉 Ketorolac
💉 Dexamethasone

The other three vanish from every OR, ASC, office procedure room, and block cart for the rest of your career.

I’m taking Lidocaine + Dexamethasone.

Lidocaine is too versatile to lose. Local infiltration, nerve blocks, antiarrhythmic use, airway topicalization, IV pain reduction—you’d feel its absence every day.

Dexamethasone? Better block duration, less PONV, happier patients. Easy choice.

But I know some of you are already typing Ketamine + Dexmedetomidine and preparing for war in the comments.

👇 Drop your two and defend your choice.

Bonus question: Which drug gets picked the LEAST by anesthesia providers? 👀

06/12/2026

Most nerve injuries don’t happen because you touched the nerve.

They happen because someone kept injecting when the nerve was telling them to stop.

A = preferred target ✅
Tangential to the nerve. Local anesthetic is deposited outside the epineurium. This is generally the safest strategy when a nerve is the target.

B = intraneural, likely extrafascicular ⚠️
The needle may enter the nerve but remain outside the fascicles. This may not result in permanent nerve injury, but it can cause paresthesia and potentially a prolonged block. Not where we want to intentionally inject.

C = intrafascicular injection 🚨
This is the danger zone. Local anesthetic is injected into a fascicle, pressure rises, and the risk of nerve injury increases.

The key point: if injection pressure is high, stop.

An experienced block assistant or clinician should recognize resistance to injection. Pressure-monitoring or pressure-limiting devices can help, but the most important safety device is still the person holding the syringe.

Also: know your needle.

Some block needles are designed with a blunter tip when the nerve itself is the target. Others are sharper and better suited for fascial plane blocks where tissue pe*******on is the goal.

Needle choice matters. Needle trajectory matters. Injection pressure matters.

📱 Search PNBschool: Anesthesia & CME on the App Store.

16 free regional anesthesia modules, labeled ultrasound anatomy, procedural block videos, 1,500+ board review questions, pharmacology, coexisting disease content, and up to 10 hours of accredited CME/CE annually.

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