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Ultrasound Guided Nerve Blocks (UGNBs) provides targeted analgesia that can effectively alleviate pain from injuries or painful procedures while reducing opioid use.
In 2021, ACEP issued a policy statement affirming that ultrasound-guided regional anesthesia is within the scope of EM physicians and is a core component of multimodal pain management pathways in the ED. However, EM residencies have not uniformly defined nerve block requirements, resulting in a wide range of graduating resident skill levels. Recent ACGME updates may help standardize expectations and address this gap.
A recent review of the National Ultrasound-Guided Nerve Block Registry (NURVE) looked at the impact of operator training level on the analgesic effectiveness of ED-performed UGNBs. The most commonly performed block among attendings was the erector spinae block, while for residents it was the fascia iliaca block. Both resident and attending performed blocks showed a reduction in pain but there was an 80.7% meaningful pain reduction in attendings as compared to 63.4% for residents. Out of the 1595 nerve block cases reviewed there were only 2 complications which included transient episode of LAST and respiratory difficulty from suspected diaphragmatic hemiparesis.
These findings highlight the importance of experience while supporting the safety and effectiveness of UGNBs performed by supervised residents in the training environment.
References
Macias M, Driver L, Riscinti M, Dreyfuss A, et al. Training level and analgesic outcomes of ultrasound-guided nerve blocks in the emergency department: An analysis from the NURVE block registry, The American Journal of Emergency Medicine, 2026 doi.org/10.1016/j.ajem.2026.01.050.