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.

07/29/2026

The femoral nerve block fell out of favor for knee surgery because of quadriceps weakness and fall risk. But there are still two situations where it’s the right call. Both come down to timing — what the patient actually has to do with that leg after surgery.

📲 PNBschool — free on the App Store and Google Play. Link in bio.
• 16 free regional anesthesia block modules
• 60+ anesthesia pharmacology modules
• 60+ anesthesia & coexisting disease modules
• Board review question bank — practice and exam modes
• Up to 10 hours AMA PRA Category 1 or ANCC credit

1️⃣ ACL reconstruction. These patients are locked out in a brace and minimally weight-bearing, so a motor block doesn’t interfere with early rehab. Femoral plus sciatic is a strong technique here.

2️⃣ Total knee arthroplasty. Do the adductor canal block and IPACK as usual, then add a short-acting femoral with chloroprocaine. It covers the early window and wears off before the patient walks a few hours later. I use this for some of my predictable sensitive patients.

Easy block to perform, and two cases where it still earns its place.

07/28/2026

Ranked 1 on the App Store for “anesthesia board review.” 🥇

Not a claim we made up — search it yourself.

Here’s what’s inside the PNBschool app:

📚 BOARD REVIEW
1,500+ exam-style questions. Practice by topic or mixed. Timed exam simulation that mirrors real testing conditions. Every question you miss gets tracked so you can drill your weak areas instead of guessing at them. Get the daily question of the day pushed to your phone!

🩻 REGIONAL ANESTHESIA — FREE FOREVER
16 ultrasound-guided block modules. Anatomy, technique, sonoanatomy, and the tips that only come from doing thousands of them. No paywall, no trial, no catch.

💊 ANESTHESIA PHARMACOLOGY
Over 60 drug modules. Mechanism, dosing, onset, duration, and the clinical considerations that actually change what you do in the room.

🫀 ANESTHESIA & COEXISTING DISEASE
60+ modules on the patients who make you think twice. Cardiac, endocrine, neuro, pulmonary, renal — how the disease changes the anesthetic, not just what the disease is.

🎓 CME
Up to 10 hours AMA PRA Category 1 or ANCC. Earn credit on the same content you’re already using to get better at your job.

Built by an anesthesia professional, for anesthesia professionals. Free to download — board review and CME with subscription.

Link in bio. 👆

07/28/2026

Beta-blockers aren’t for everyone anymore — but for the right patient, they’re still one of the sharpest tools in the room. Continue them when they’re chronic, avoid starting them the day of surgery, and know the line between a cardiac indication and an analgesic bonus.

Review esmolol and the properties of all the common beta-blockers in the PNBschool mobile app.

Everything inside:

• 16 ultrasound-guided regional anesthesia block modules — free forever
• Over 60 anesthesia pharmacology modules
• 60+ anesthesia & coexisting disease modules
• Board review question bank — 1,500+ questions, practice and exam modes
• Up to 10 hours AMA PRA Category 1 or ANCC CME

Available now on the App Store and Google Play. Link in bio.

Educational material for the anesthesia professional. For educational purposes only — always follow current guidelines and institutional protocol.

07/26/2026

One last look before induction.

Guillain-Barré is the case where the reassuring number lies to you.

You pull a BMP. Potassium is 4.1. Everything looks fine. But the hyperkalemia risk in GBS was never about the serum value — it’s receptor-mediated. Denervation drives extrajunctional acetylcholine receptor upregulation, and succinylcholine opens every one of them at once. A normal potassium tells you nothing about how many receptors are waiting.

And the window is longer than most people assume. The risk isn’t confined to the acute, floridly weak patient. It persists through recovery — generally at least six months out, and longer while any weakness remains. The patient walking into your room for an unrelated case, months past their diagnosis, is still the patient you don’t give succinylcholine to.

The other one people underestimate: autonomic dysfunction. Labile blood pressure, heart rate swings, exaggerated responses to vagal stimuli. Plan for it before laryngoscopy, not after.

Save this one. You will not want to be looking it up.

—

Inside the PNBschool app:

✓ 16 ultrasound-guided regional block modules — free forever
✓ 60+ anesthesia pharmacology modules
✓ 60+ anesthesia and coexisting disease modules
✓ Board review question bank — 1,500+ questions, practice mode and exam mode
✓ Up to 10 hours AMA PRA Category 1 or ANCC CME

Buying board review, CME, and procedural education separately runs several hundred dollars a year. All of it is bundled here for $99.99 a year.

Built by a practicing anesthesia professional, for anesthesia professionals.

Download free — iOS and Android. Link in bio.

Educational content for anesthesia professionals. Practice varies. For educational use only.

07/26/2026

Anesthesia Truth’s🤷🏻‍♂️

07/26/2026

TAP blocks were never meant to cover the midline of the abdomen. But there’s a simple solution.

📲 Download the PNBschool Mobile App — on the App Store and Google Play. Trusted by 50,000+ anesthesia professionals.

• 16 ultrasound-guided regional nerve block modules — FREE
• 60+ anesthesia pharmacology cards
• 60+ coexisting disease cards
• Up to 10 hours AMA PRA Category 1 Credit™ or ANCC nursing contact hours
• Complete anesthesia board review system — 1,500+ questions, practice and exam modes

Link in bio. Download now, free.

So here’s the fix.

The TAP block deposits between internal oblique and transversus abdominis and covers the lateral abdominal wall well. But the anterior cutaneous branches that supply the midline never reach that plane. That’s why your midline laparotomy patient still hurts straight down the center after a textbook-perfect TAP — and why people quietly conclude the block “didn’t work.”

It worked. It just doesn’t cover the midline.

The answer is to add bilateral re**us sheath blocks.

Four blocks total. Bilateral TAP for the flanks, bilateral re**us sheath for the midline. Consistent coverage of the entire abdominal wall, and no more guessing about why the center still hurts.

That’s the abdominal block nobody teaches you. Full module, free in the app.

07/25/2026

63% longer analgesia from 30 mcg. In ultrasound-guided regional anesthesia, the route you pick decides whether you get any of it.

📲 The PNBschool Mobile App— free on iOS and Google Play (Link in our Bio)
• 60+ Anesthesia Pharmacology modules
• 60+ Anesthesia & Coexisting Disease modules
• Full board review system, over 1500 board questions, practice and exam modes
• Up to 10 hours AMA PRA Category 1 Credit™ or ANCC contact hours

Over 20,000 downloads!

THE EVIDENCE — 32 trials, 2,007 patients
• Sensory ≥57% longer
• Motor ≥58% longer
• Analgesia ≥63% longer
• All P < 0.0001 vs local anesthetic alone

DOSE
• 30–50 mcg is the sweet spot
• Roughly 5 extra hours with long-acting LA
• No added benefit above 50 mcg

ROUTE MATTERS
• Perineural: +318 min analgesia
• IV dexmedetomidine: no block prolongation
• Dexamethasone still outperforms dex for sensory duration

CAUTIONS
• Transient bradycardia, hypotension, sedation
• Prolonged motor block — may delay discharge
• Perineural use is off-label

Sources: Br J Anaesth 2017;118:167–181 | BMC Anesthesiol 2021;21:233 | Anaesthesia 2021;76:974–990

Adjuvants are a judgment call, not a recipe. Know the mechanism, respect the trade-off, counsel the patient in front of you.

07/23/2026

The interscalene is the block that tells on you.

It’s common — but it isn’t casual. Cervical roots carry motor and sensory fibers, so a poorly placed needle doesn’t just fail, it announces itself. Body habitus changes everything about what you see: short necks, deep planes, and variable anatomy can turn a textbook stoplight into a guessing game.

Good technique erases most of that.

▪️ Stay in plane. Every time. If you lose the shaft, stop and re-find it.
▪️ Visualize the tip — not the shaft you assume is the tip.
▪️ Soft fingers. The needle should feel like it’s floating. Force is information you’re ignoring.
▪️ Talk to your patient. Paresthesia is data. Ask for it, respond to it, redirect.
▪️ Watch the spread. Local that doesn’t move where you expect means you’re not where you think.
▪️ Target by surgery. C5–C6 for the shoulder. Drop lower for elbow and biceps coverage. Know which one you’re after before the needle moves.

When this block stops feeling like an event and starts feeling routine — that means you hit the next level!

16 block modules free in the PNBschool app, including this one. Link in bio.

Follow for more, and send this to someone who’s still fighting the interscalene.

07/22/2026

Same 10 CME hours. $59 less. And the whole platform comes free.

CME for CAAs charges $159 for a single 10-hour short course. One course, then you’re done.

PNBschool gives you the same 10 hours of CME credit for $99.99/year — plus everything below, included free:

• 1,500+ board review questions with Practice & Exam modes and Question of the Day
• Over 60 pharmacology modules
• 60+ coexisting disease modules
• 16 regional block modules
• Full year access

You were spending the money on CME anyway. Spend less and get the whole platform.

📲 Download PNBschool on iOS and Google Play.

07/22/2026

Promises, promises.

Would you ever tell a patient they’ll have zero pain because of the nerve block? It’s tempting — the block looks beautiful, the spread is perfect, and the patient wants reassurance. But the block that works 95% of the time is still the block that fails on somebody, and that somebody remembers exactly what you told them.

LEARN REGIONAL THE RIGHT WAY — PNBschool mobile app (link in bio)
• 1,500 board-style questions with Practice Mode and Exam Mode
• Up to 10 AMA PRA Category 1 Credits™ or ANCC contact hours
• 60+ pharmacology modules
• 60+ coexisting disease modules
• Start with 16 regional block modules — FREE

HOW I ACTUALLY TALK TO PATIENTS ABOUT IT

The golden rule is under-promise and over-deliver. What patients really want to hear isn’t a guarantee — it’s that you’re putting time and effort into making sure their pain is treated to an appropriate level. That’s the promise you can actually keep.

So the language I use: this block will help control your pain for a set number of hours, and pain medicine is available if you need it. Two things that stay true no matter how the block turns out.

A few realities worth saying out loud:

• Not every regional technique works. There’s always a risk of failure.
• Some blocks aren’t designed to cover 100% of the pain — motor-sparing techniques trade some analgesia for function, and that’s a deliberate compromise.
• We don’t limit opioids just because we did a block. Regional is part of the plan, not a replacement for the rest of it.

WHY THESE FOUR BLOCKS?
Popliteal sciatic — may need a saphenous block to cover the medial tarsal strip.
Axillary — make sure to get the musculocutaneous nerve; some would choose infraclavicular here.
Interscalene — block C7 for any biceps work.
Supraclavicular — very reliable below the elbow in my opinion, if performed correctly.

What do they have in common? Tell me in the comments why you think I picked these four — and which ones you’d add.

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