We hope you find the content on this website valuable in your pursuit of advanced knowledge and practical exposure to the wide range of analgesic and diagnostic techniques available through ultrasound imaging. This resource is designed to support your understanding of key concepts, familiarize you with the risks and benefits of ultrasound guidance, and provide foundational insights into the placement and management of peripheral nerve blocks, as well as other procedures discussed herein.
Important Notice:
This content is intended for informational and reference purposes only. It is not a substitute for formal training, nor is it designed to diagnose or treat any medical condition. Providers are solely responsible for clinical decision-making and patient care, and Twin Oaks Anesthesia assumes no liability for any actions taken based on the use of this material.
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We strongly encourage all providers to attend a formal training course with Twin Oaks Anesthesia. Our comprehensive educational programs are designed to deepen your understanding of ultrasound-guided procedures, reinforce evidence-based practice, and offer hands-on instruction to ensure clinical proficiency and confidence.
Interscalene Nerve block
Interscalene blocks performed using a nerve stimulator are considered among the most technically challenging regional anesthesia techniques. The anatomical complexity of the brachial plexus in the cervical region, combined with redundant soft tissue, often makes reliable landmark identification difficult. These factors contribute to a relatively high risk of complications, with reported success rates ranging from 75% to 80% in the literature.
PECs Nerve Block
Until recently, patients undergoing anterior chest wall procedures involving the pectoral muscles—such as breast reconstruction—had limited regional anesthesia options for intraoperative and postoperative pain management. These options primarily included thoracic epidural anesthesia and, more commonly, thoracic paravertebral blocks. Given that many of these reconstructive procedures are now performed on an outpatient basis, thoracic epidural anesthesia has become a less favorable choice due to its invasive nature and the potential for increased patient risk.
Saphenous Nerve Block
The saphenous nerve block serves as a valuable adjunct to the various sciatic nerve block techniques, providing targeted sensory coverage to the medial aspect of the lower leg and calf. The saphenous nerve is a terminal, purely sensory branch of the femoral nerve. In contrast, motor innervation to the lower leg is predominantly supplied by the distal branches of the sciatic nerve. The saphenous nerve typically branches from the femoral nerve approximately midway along the length of the femur.
Popliteal Nerve Block
The term “popliteal nerve” is often used to refer to the continuation of the mid-sciatic nerve; however, it is somewhat of a misnomer. While the name accurately reflects its anatomical location within the popliteal fossa, the sciatic nerve has typically already bifurcated into its two terminal branches—the tibial and common peroneal nerves—by the time it reaches this region, particularly in relation to the popliteal artery and vein.
As illustrated by Dr. Frank Netter, the sciatic nerve maintains its singular structure deep within the musculature of the posterior thigh before dividing proximally to the popliteal fossa. It gives rise to the common peroneal nerve laterally and the tibial nerve medially, both of which continue through the popliteal space to innervate the distal lower extremity.
TAP Nerve Block
As recently as 2001, a novel technique for providing analgesia to the anterior abdominal wall was introduced: the Transversus Abdominis Plane (TAP) block. This approach involves the deposition of local anesthetic between the internal oblique and transversus abdominis muscles—the two deepest layers of the abdominal wall. The TAP block provides effective somatic analgesia to the anterior abdominal wall, making it a viable alternative to epidural anesthesia for a variety of abdominal surgical procedures.
TTE
The purpose of this content is to introduce critical care providers to the fundamental principles and basic techniques of bedside transthoracic echocardiography (TTE). It is important to note that this material is not intended to serve as a comprehensive guide to TTE, nor does it confer certification or clinical credentialing in its use. Rather, it is designed to spark interest, highlight the clinical value of bedside echocardiography in the critical care setting, and encourage continued education and skill development in this essential area of practice.
Difficult IV Access With Ultrasound
Ultrasound guidance significantly facilitates venous cannulation in patients with difficult vascular access. Certain patient populations—such as those with obesity, renal failure, or a history of multiple vascular procedures—often present unique challenges, including limited access sites due to surgical restrictions or existing grafts. In these cases, a targeted approach informed by knowledge of optimal probe placement can greatly reduce the time and difficulty associated with locating a viable vein.
Sphenopalatine Block
The sphenopalatine ganglion (SPG) block is not a novel technique, but it has recently experienced renewed interest within the anesthesia community. Originally described by Dr. Greenfield Sluder in 1908, the SPG block has been recognized for over a century as an effective intervention for a variety of clinical indications.
Erector Spinea Block
With the increasing frequency of trunk surgeries—including thoracotomies, plastic procedures, and operations involving the chest and abdomen—the demand for effective regional pain control continues to grow. For decades, thoracic and lumbar epidural techniques were considered the primary options for managing pain in these areas. However, their limitations and potential risks often render them unsuitable or impractical for routine use by anesthesia providers.
Introduction to Gastric Ultrasound
If you’re ready to explore the fundamentals of gastric ultrasound for assessing prandial status, this is an excellent place to begin. During our instructional session—later featured in Anesthesiology News—we successfully improved correct identification of a full stomach among a large cohort of student registered nurse anesthetists (SRNAs) from a baseline of 30% to 96%, all within the span of a single, concise presentation.
Ultrasound-Guided INTRAPEC Injection
Regional anesthesia for plastic surgery presents unique challenges for anesthesia providers. Two key concerns include the complex and often poorly defined pain pathways associated with the broad and variable surgical fields, as well as the increased risk of local anesthetic systemic toxicity (LAST). The latter is frequently attributed to the additional volumes of local anesthetic administered intraoperatively by surgeons, commonly in the form of tumescent solution.
Cervical Plexus Block
The cervical plexus block is most commonly associated with analgesia for carotid endarterectomy. However, its clinical utility extends beyond this indication. Recent literature highlights its effectiveness in a range of procedures, including clavicle surgery, airway interventions, thyroidectomy, submandibular surgeries, and various types of neck dissections.
