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.

09/18/2026

“The fascia iliaca block doesn’t work.”

It works. It’s just usually done with too little local. The FICB is a volume block — you are asking fluid to travel under a fascial plane far enough to reach three nerves, and 20 mL will not get you there. Find the “bow tie” where the internal oblique and sartorius cross, place your needle under the fascia iliaca, and inject 40–50 mL. Dilute your local to accommodate that volume.

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

Subscribe for over 70 pharmacology cards, 60+ coexisting disease cards, 1,500+ board review questions, and up to 10 hours AMA PRA Category 1 Credit or ANCC contact hours. For CRNAs, counts toward Class B credit.

Link in bio — App Store and Google Play.

What you’re covering: femoral and lateral femoral cutaneous nerves. Obturator spread is inconsistent — don’t build your plan around it. That makes this a strong choice for hip fracture and femoral shaft fracture pain, and for anterior thigh skin graft donor sites.

Watch the spread. Correct injection lifts the fascia and pushes the iliacus muscle away. If your local is pooling in one spot instead of tracking medially and laterally, you’re above the fascia, not under it.

What volume are you using for your FICB? 👇

09/17/2026

Your CME allowance resets whether you use it or not. Most of it goes to one conference, one hotel, and a folder of handouts nobody opens again. A full year of board review, pharmacology, coexisting disease, and regional technique costs less than two nights at that hotel — and it lives on your phone during the case, not in a folder.

Tap the link in bio → download free → see what’s unlocked before you spend a dollar.

The PNBschool Mobile app:
• Question of the Day — free, pushed to your phone
• 16 regional block modules — free
• 3 pharmacology + 3 coexisting disease modules — free
• 1,500+ board review questions
• Over 70 pharmacology cards
• 60+ coexisting disease cards
• Step-by-step regional block tutorials
• Up to 10 hours AMA PRA Category 1 Credit™ or ANCC contact hours (CRNAs: Class B; may count toward Class A if approved)

App Store and Google Play. Link in bio.

The reason to look now rather than in December: CME dollars are use-it-or-lose-it at most groups, and the last-week scramble is how people end up buying whatever is fastest instead of whatever they’ll actually open. One app covers boards, pharm, coexisting disease, and blocks — and the regional side stays free forever whether you ever spend the allowance here or not.

09/17/2026

Tips no one tells you: how to visualize your needle 🎯

Can’t see your needle? Most of the time it’s the angle, not the needle. When the needle goes in too steep, the ultrasound beam bounces away from the transducer, no echo returns, and the shaft disappears from your screen.

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

3 ways to bring your needle back:

1️⃣ Pick a better entry point. Your entry point and the depth of your target decide how steep the needle has to be. For deeper targets, enter farther from the transducer to flatten the trajectory.

2️⃣ Sink the transducer. The pro move: use pressure to compress the patient’s adipose so the transducer face runs parallel with the needle.

3️⃣ Use an echogenic needle. Needles with built-in reflectors send more sound back to the transducer, even when your angle isn’t perfect.

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

09/16/2026

It’s not all just black and white. Bright (hyperechoic) structures like fascia and bone are dense and send most of the sound back to the probe. Fluid-filled structures like vessels show up dark, and muscle falls somewhere in between depending on the patient.

📲 Learn all 16 ultrasound-guided block techniques in the PNBschool Mobile app. Link in bio, available on the App Store and Google Play.
✅ 16 regional block modules + Question of the Day, FREE
✅ Up to 10 hours AMA PRA Category 1 Credit or ANCC contact hours
✅ 1,500+ board review questions
✅ 60+ coexisting disease modules
✅ Over 70 pharmacology modules

🔹 TAP block: those bright fascial lines separate the external oblique, internal oblique, and transversus abdominis. Your target is the plane between the internal oblique and transversus abdominis.

🔹 Femoral nerve block: lower extremity nerves carry more connective tissue, so they look brighter than you might expect. Compare that to the roots at the interscalene level, which look dark.

What structure took you the longest to recognize when you started scanning? 👇

09/15/2026

Can you label all 7 structures before the answer drops? 🧠 The adductor canal is a tunnel in the thigh: sartorius forms the roof, vastus medialis the lateral wall, and adductor longus the posteromedial wall. Inside it run the saphenous nerve, femoral artery, and femoral vein.

Master every block in the PNBschool Mobile app:
✅ 16 regional block modules (FREE)
✅ Question of the Day pushed to your phone (FREE)
✅ 1,500+ board review questions
✅ Up to 10 CME hours
✅ Over 70 pharmacology modules
✅ 60+ coexisting disease modules
📲 Link in bio: App Store & Google Play

Clinical pearl: don’t stop lateral to the artery. Depending on your level, saphenous branches can run medial, so hydrodissect superficial to the artery to carry spread across. 15–25 mL.

Comment your score out of 7 👇

09/14/2026

PENG is a great block — it just isn’t the whole hip. The skin incision for a total hip lives in lateral femoral cutaneous nerve territory, and PENG was never designed to reach it. Block the LFCN in the right place and you cover both the anterior and the posterolateral incision.

Everything you need to perform this block is in the PNBschool Mobile app:

• 16 regional block modules — FREE
• Question of the Day, pushed to your phone — FREE
• 3 pharmacology modules + 3 coexisting disease modules — FREE
• Over 70 pharmacology modules
• 60+ coexisting disease modules
• 1,500+ board review questions
• Up to 10 hours AMA PRA Category 1 Credit / ANCC contact hours

Link in bio — App Store & Google Play

Where you place the transducer decides whether this block works. Scan 1–2 cm medial and inferior to the ASIS and find the plane between fascia lata and fascia iliaca, superficial and lateral to sartorius. The nerve has almost always already divided by the time you see it — you are looking for two small structures, not one.

That branching is the whole point. The anterior branch supplies the anterolateral thigh and covers a direct anterior incision. The posterior branch runs over the lateral thigh from the greater trochanter down and covers a posterolateral incision. Block proximally, before or at the division, and you get both.

Flood the plane, don’t chase the nerve. 5–10 mL is enough when the spread is right.

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.

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Middleburg Heights, OH
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