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.

09/06/2026

Ortho Bro’s Bible says:

1. Need relaxation
2. Need Ancef
3. Need TXA
4. Need 2 rooms
5. Need Hammer
6. Need rep
7. Need you to be on time but they will be late
8. Need faster turnover
9. Need administrator
10. Need to do their case first on the weekend

Remember to thank an ortho bro for your job today.

09/05/2026

Do you have an Android Phone? Would you like full access to the PNBschool Anesthesia and CME Mobile App?

Comment “Free” and I will DM you the details.

09/05/2026

The femoral triangle sits just proximal to the adductor canal, bordered by sartorius laterally and adductor longus medially. Same transducer orientation as an adductor canal block — simply slide proximal. At that level the anatomy takes on a shape you can’t unsee: the whale.

📲 The PNBschool Mobile app — link in bio, on the App Store and Google Play:
• 16 regional block modules — FREE
• Question of the Day, pushed to your phone — FREE
• 3 pharmacology modules and 3 coexisting disease modules — FREE
• 1,500+ board review questions
• Over 70 pharmacology cards
• 60+ coexisting disease cards
• Up to 10 hours AMA PRA Category 1 Credit or ANCC contact hours (for CRNAs, counts toward Class B; may count toward Class A if approved)

WHERE IS THE FEMORAL TRIANGLE?
Its borders are the inguinal ligament superiorly, sartorius laterally, and adductor longus medially. The apex is where sartorius crosses over adductor longus — distal to that point you are in the adductor canal. Scan at the distal third of the triangle, just proximal to that crossing.

WHAT IS THE WHALE SIGN?
Sartorius forms the rounded head and back of the whale, the femoral artery and vein sit beneath it as the eye, and adductor longus tapers away medially as the tail. Once the whale appears on your screen, you know your level is correct.

FEMORAL TRIANGLE VS. ADDUCTOR CANAL — WHAT’S THE DIFFERENCE?
It comes down to level, and level determines what you can see. At the femoral triangle you can visualize the nerve to vastus medialis alongside the saphenous nerve, which may give a more complete block of the knee than an adductor canal injection alone. Same probe orientation, same patient position — only the level changes.

Where do you scan for your knee blocks? Comment below.

09/04/2026

Both work. That’s what makes this worth asking.

Double lumen tube or bronchial blocker — either one gets you lung isolation. But most of us reach for the same thing every single time without really thinking about it. The one we trained on. The one that’s stocked. The one already sitting on the cart.

So what’s actually driving it? The airway? The surgery? Where the patient goes after? Or just habit?

Double lumen or blocker — and more importantly, why that one? Drop it in the comments.

09/03/2026

Most CME cycles close December 31, which means the scramble starts right about now. The credit is the same whether you earn it in a conference ballroom or in the 20 minutes between a room turnover — what changes is what it costs you in time, travel, and days off.

The PNBschool Mobile app puts it on your phone:

✅ Up to 10 hours AMA PRA Category 1 Credit or ANCC contact hours
✅ 1,500+ board review questions
✅ 16 regional block modules
✅ Over 70 pharmacology modules
✅ 60+ coexisting disease modules
✅ Question of the Day, pushed to your phone

📲 Download free on the App Store and Google Play — link in bio

Included free content for everyone: all 16 regional block modules, Question of the Day, 3 pharmacology modules, and 3 coexisting disease modules. For CRNAs, the ANCC CE hours count toward Class B and may count toward Class A if approved. Accredited by Pinnacle.

One subscription. Reimbursed by your department. No hotel, no flight, no lost clinical day.

09/03/2026

The PENG is a field block. You are not chasing a nerve — you are laying local in the plane between the psoas tendon and the p***c ramus and letting it spread to the articular branches of the femoral, obturator, and accessory obturator nerves. Needle on bone, deep to the tendon, 15-20 mL. Watch the local spread medial and lateral.

📲 The PNBschool Mobile app:
• 16 regional block modules — free
• Question of the Day, pushed to your phone — free
• 70+ anesthesia pharmacology modules
• 60+ coexisting disease modules
• 1,500+ board review questions
• Up to 10 hours AMA PRA Category 1 Credit or ANCC contact hours

Link in bio — App Store and Google Play.

For total hips, add an LFCN block. The PENG covers the anterior capsule, the LFCN covers the lateral skin and the incision. Both are motor sparing, so the patient still gets up and walks.

And that is the point — done correctly, the PENG does not take the quad. Stay on bone, stay deep to the tendon, keep the volume where it belongs.

09/02/2026

What’s your go-to block needle?

Mine changes with the block — and it’s mostly about length.

**2-inch blunt tip — interscalene.** The target is shallow. A longer needle just gets in your way and makes shallow-angle control harder.

**4–6 inch blunt tip — adductor canal + IPACK.** Enough length to reach both targets, so I’m not switching needles halfway through the leg.

**Sharp TAP needle — TAP + re**us sheath.** No nerve is the target here. A long bevel cuts through muscle with less drag and less deflection.

Blunt/short bevel gives you the tactile pop through fascia and pushes nerves and vessels out of the way instead of through them — that’s why it stays standard for perineural work.

Why PAJUNK: cornerstone reflectors for echogenicity, customer service that actually answers, and never a backorder — not once, not even in 2020.

What length are you reaching for, and for which block? 👇

09/01/2026

Most people put the needle lateral to the femoral artery, drop 15–25 mL, and call it done. That covers the saphenous nerve where it sits under sartorius — but it assumes every patient’s saphenous nerve stays in one place. It doesn’t.

Here’s the pro tip: inject lateral to the artery, then hydrodissect superficial to the artery and carry your spread medially too. See below for the reason this matters…

📲 The PNBschool Mobile app — free:
• 16 regional block modules
• Question of the Day pushed to your phone
• 3 pharmacology modules
• 3 coexisting disease modules

Unlock more: 1,500+ board review questions, or CME Access for everything plus up to 10 hours AMA PRA Category 1 Credit™ / ANCC contact hours.

Link in bio — or search PNBschool on the App Store and Google Play.

Why the medial spread matters: depending on the level you perform the block, the saphenous nerve has already given off branches that run medial to the artery. In some patients those branches are barely there. In others they’re prominent — and if all your local sits lateral, that’s exactly where your coverage falls short. Recent studies have also suggested the medial injection, with volume may add analgesia posteriorly as the local spreads along fascia.

Take the extra 30 seconds. Lateral, then superficial and medial.

What level do you scan at for your adductor canal block? 👇

08/31/2026

Board review pricing in anesthesia has drifted a long way from what this material costs to deliver. A year of TrueLearn NCCAA is $439. Ninety days is $309. The nearest comparable app is $179.99 for twelve months. All publicly listed prices, August 2026.

The PNBschool Mobile App board review system costs $39.99 a year.

What you get:
• 1,500+ board review questions — practice by topic, timed exam simulation, review your misses
• A new “Question of the Day” pushed to your phone every day — free for everyone
• 16 ultrasound-guided regional block modules — free for everyone
• Over 70 pharmacology cards
• 60+ coexisting disease cards
• Up to 10 hours AMA PRA Category 1 Credit or ANCC contact hours (for CRNAs, counts toward Class B; may count toward Class A if approved)

Two tiers:
Board Review System — $39.99 / year
CME Individual Annual — $99.99 / year, includes the board review system plus full CME

Link in bio. Download free on the App Store and Google Play.

At $39.99 for a full year, the math stops being a decision. Study on the drive in, between cases, the night before. It’s on your phone either way.

08/31/2026

This is a 29s reel. 29s to learn how to visualize your needle better.

Needle visibility comes down to how parallel the needle sits to the ultrasound beam. Steep angles scatter sound waves away from the transducer instead of back to it — and the shaft vanishes. Three fixes below.

📲 Free in the PNBschool Mobile app:
• Question of the Day — pushed to your phone
• 16 regional block modules
• 3 pharmacology modules
• 3 coexisting disease modules

Full access adds 1,500+ board review questions, up to 10 CME hours, over 70 pharmacology modules and 60+ coexisting disease modules.

Link in bio — App Store & Google Play

1️⃣ MOVE YOUR ENTRY POINT
The further your entry sits from the transducer, the easier it is to hold a parallel approach. Small change in entry, big change in what you see.

2️⃣ SINK THE PROBE
Apply pressure to one edge of the transducer and reshape the adipose underneath it. You’re flattening the angle between beam and needle. Some patients won’t tolerate much pressure — know that going in.

3️⃣ USE A NEEDLE BUILT FOR IT
Echogenic needles with cornerstone reflectors return sound waves back to the transducer regardless of insertion angle.

Better angle. Better reflection. Better visualization.

What’s your go-to move when you lose the needle? 👇

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Middleburg Heights, OH
44130

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