Top 20 Ultrasound-Guided Blocks in the Emergency Department

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Upper Extremity

  • Supraclavicular Brachial Plexus Block

  • Interscalene Block

  • RAPTIR Block

  • Radial Nerve Block (Supracondylar)

  • Median Nerve Block

  • Ulnar Nerve Block

  • Ultrasound-Guided Flexor Tendon Sheath Block

Lower Extremity

  • Infrainguinal Fascia Iliaca Block

  • Suprainguinal Fascia Iliaca Block

  • PENG Block

  • Proximal Sciatic Nerve Block (Trans-Gluteal)

  • Popliteal Sciatic Nerve Block (Distal Sciatic Nerve Block)

  • Distal Tibial Nerve Block (Posterior Tibial Nerve Block)

  • Saphenous Nerve Block (Adductor Canal Block)

Truncal Blocks

  • Serratus Anterior Plane Block

  • Erector Spinae Plane Block

  • Transversus Abdominis Plane (TAP) Block

  • Rectus Sheath Block

Head & Neck / Shoulder Region

  • Superficial Cervical Plexus Block

  • Clavipectoral Fascial Plane Block


Learning Ultrasound-Guided Nerve Blocks

Emergency physicians interested in expanding their use of regional anesthesia can learn these techniques through hands-on training, cadaver labs, and structured educational programs.

BlockHeads courses focus on practical ultrasound-guided regional anesthesia techniques that can be safely implemented in the emergency department.

Explore upcoming courses and educational resources to continue developing your nerve block skills!

A Practical Guide for Emergency Physicians

Ultrasound-guided regional anesthesia is rapidly becoming a core procedural skill in modern emergency medicine. For many common injuries seen in the emergency department — fractures, dislocations, rib injuries, and complex lacerations — nerve blocks can provide rapid, targeted analgesia while reducing reliance on opioids and procedural sedation.

At BlockHeads, we focus on practical techniques that emergency physicians can integrate into everyday clinical practice. The following list highlights 20 ultrasound-guided nerve blocks that are particularly useful in the emergency department, emphasizing approaches that are effective, reproducible, and well suited to the point-of-care ultrasound environment.

Blocks are organized by anatomic region, reflecting common emergency department presentations and the way clinicians typically approach regional anesthesia at the bedside

Upper Extremity Blocks

Supraclavicular Brachial Plexus Block

Provides dense anesthesia for most procedures distal to the shoulder.

Best for

  • Forearm fractures

  • Wrist injuries

  • Hand procedures

Clinical Pearl

Look for the classic “cluster of grapes” appearance of the brachial plexus lateral to the subclavian artery.

Interscalene Block

Provides excellent analgesia for shoulder pathology.

Best for

  • Shoulder dislocation reduction

  • Proximal humerus fractures

Clinical Pearl

Identify the brachial plexus roots between the anterior and middle scalene muscles.

RAPTIR Block (Retroclavicular Approach to the Infraclavicular Region)

A variation of the infraclavicular brachial plexus block that targets the cords of the plexus while improving needle visualization.

Best for

  • Elbow injuries

  • Forearm fractures

  • Wrist and hand procedures

Clinical Pearl

The retroclavicular needle trajectory often provides excellent alignment with the ultrasound beam, improving needle visualization.

Radial Nerve Block — Supracondylar Approach

Provides anesthesia to the dorsal hand and wrist.

Best for

  • Distal radius fractures

  • Dorsal hand lacerations

  • Metacarpal fractures

Clinical Pearl

Start scanning at the mid-humerus where the nerve exits the spiral groove, then track distally toward the supracondylar region.

Median Nerve Block

Provides anesthesia to the palmar hand.

Best for

  • Palmar hand lacerations

  • Carpal tunnel procedures

  • First–third digit injuries

Clinical Pearl

Start scanning distally in the carpal tunnel and track proximally to confirm nerve identity.

Ulnar Nerve Block

Provides anesthesia to the medial hand and fifth digit.

Best for

  • Fifth digit injuries

  • Medial hand lacerations

Clinical Pearl

Distally the nerve separates from the ulnar artery into its own fascial plane.

Ultrasound-Guided Flexor Tendon Sheath Block (Ultrasound Guided Digital Block)

Provides targeted analgesia for individual digits through anesthetic deposition within the flexor tendon sheath.

Best for

  • Finger laceration repair

  • Finger fracture reduction

  • Nail bed procedures

Clinical Pearl

Identify the flexor tendon within the tendon sheath on ultrasound and inject small volumes while visualizing spread within the sheath.

Lower Extremity Blocks

Infrainguinal Fascia Iliaca Block

A commonly used technique for hip fracture analgesia.

Best for

  • Hip fractures

  • Femoral neck fractures

Clinical Pearl

Ensure the needle tip is deep to the fascia iliaca, with hydrodissection lifting the fascia.

Suprainguinal Fascia Iliaca Block

Allows more reliable spread toward lumbar plexus branches.

Best for

  • Hip fractures

  • Acetabular injuries

Clinical Pearl

Position the probe just medial to the ASIS and align it along the iliac crest.

PENG Block (Pericapsular Nerve Group Block)

Targets articular branches supplying the anterior hip capsule.

Best for

  • Hip fracture analgesia

  • Hip dislocation reduction

Clinical Pearl

The injection target lies near the iliopubic eminence along the superior pubic ramus.

Proximal Sciatic Nerve Block (Trans-Gluteal Approach)

Provides anesthesia to most of the lower leg and foot.

Best for

  • Tibia and fibula fractures

  • Severe lower leg trauma

  • Extensive distal extremity procedures

Clinical Pearl

The sciatic nerve lies deep to the gluteus maximus between the greater trochanter and ischial tuberosity.

Popliteal Sciatic Nerve Block (Distal Sciatic Nerve Block)

Provides anesthesia to the lower leg, ankle, and foot.

Best for

  • Ankle fractures

  • Foot injuries

  • Distal lower extremity procedures

Clinical Pearl

Perform the block proximal to the bifurcation of the sciatic nerve into the tibial and common peroneal nerves.

Distal Tibial Nerve Block (Posterior Tibial Nerve Block)

Provides anesthesia to the plantar surface of the foot.

Best for

  • Plantar foot lacerations

  • Calcaneal injuries

  • Foreign body removal

Clinical Pearl

The nerve lies posterior to the posterior tibial artery near the medial malleolus.

Saphenous Nerve Block (Adductor Canal Block)

Provides sensory anesthesia to the medial lower leg and ankle.

Best for

  • Medial ankle injuries

  • Medial foot lacerations

Clinical Pearl

The nerve is visualized adjacent to the femoral artery beneath the sartorius muscle within the adductor canal.

Truncal Blocks

Serratus Anterior Plane Block

Provides chest wall analgesia.

Best for

  • Rib fractures

  • Thoracic trauma

Clinical Pearl

Inject between the latissimus dorsi and serratus anterior muscles.

Erector Spinae Plane Block

Provides analgesia for thoracic pain.

Best for

  • Rib fractures

  • Thoracic back pain

Clinical Pearl

Identify the transverse process beneath the erector spinae muscle.

Transversus Abdominis Plane (TAP) Block

Provides analgesia to the anterior abdominal wall.

Best for

  • Abdominal wall pain

  • Laceration repair

Clinical Pearl

Inject between the internal oblique and transversus abdominis muscles.

Rectus Sheath Block

Provides midline abdominal wall analgesia.

Best for

  • Umbilical hernia reduction

  • Periumbilical procedures

Clinical Pearl

Local anesthetic spreads within the posterior rectus sheath.

Head, Neck, and Shoulder Blocks

Superficial Cervical Plexus Block

Provides sensory blockade to the lateral neck and clavicular region.

Best for

  • Clavicle fractures

  • Neck lacerations

  • Cervical soft tissue procedures

Clinical Pearl

The cervical plexus branches emerge along the posterior border of the sternocleidomastoid muscle.

Clavipectoral Fascial Plane Block

Targets the sensory branches supplying the clavicle through local anesthetic deposition within the clavipectoral fascia.

Best for

  • Clavicle fractures

  • Clavicle procedures

Clinical Pearl

Inject local anesthetic between the clavipectoral fascia and clavicle near the fracture site.