Ultrasound-guided nerve blocks in the emergency department: head, chest wall and shoulder

What you will learn

• Set up a safe block: consent, dose calculation, monitoring, Stop Before You Block and documentation
• Recognise local anaesthetic systemic toxicity early and manage it with lipid emulsion
• Perform the sonoanatomy and needle path for the greater occipital nerve, serratus anterior plane, superior trunk and SHAC blocks
• Choose between the shoulder blocks, and recognise who should not have each one
• Summarise the evidence for each block in emergency care, and its limits

Lessons

1. Why blocks belong in the emergency department10 min
2. The safety system: dose, Stop Before You Block and toxicity18 min
3. Greater occipital nerve block for headache12 min
4. Serratus anterior plane block for rib fractures15 min
5. The shoulder: superior trunk and SHAC blocks18 min
6. Cases12 min
7. Final assessment: 12 questions, pass mark 80%7 min

Who it is for

Emergency and acute care doctors and advanced clinical practitioners who perform, or are training to perform, ultrasound-guided regional anaesthesia under their trust's governance.

Your certificate

Pass the assessment and we email your certificate as a PDF: your name, the module, 1.5 hours of CPD, the date and a code anyone can check at thewavelength.co.uk/elearning/verify. Upload it to your e-portfolio with a short reflection. Wavelength issues the certificate itself. It is not accredited by an external body, so record the hours as self-directed CPD under your own college or regulator's rules. The certificate records completed learning. Sign-off to scan independently stays with your department.

About this module

Author. Dr Firas Abou-Auda, Consultant in Emergency Medicine and Course Director, Wavelength.
Published. October 2026. Next review. October 2028.
Conflicts of interest. Dr Firas Abou-Auda is Course Director of Wavelength, which runs paid ultrasound courses.

References

1. Association of Anaesthetists. Management of severe local anaesthetic toxicity. Safety guideline. 2010.
2. Regional Anaesthesia UK and the Safe Anaesthesia Liaison Group. Stop Before You Block.
3. Friedman BW, et al. A randomized, sham-controlled trial of bilateral greater occipital nerve blocks with bupivacaine for acute migraine patients refractory to standard emergency department treatment with metoclopramide. Headache. 2018;58:1427-34.
4. Greher M, et al. Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection. British Journal of Anaesthesia. 2010;104:637-42.
5. Blanco R, et al. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia. 2013;68:1107-13.
6. Partyka C, et al. Serratus anterior plane blocks for early rib fracture pain management: the SABRE randomized clinical trial. JAMA Surgery. 2024;159:810-17.
7. Kim DH, et al. Superior trunk block: a phrenic-sparing alternative to the interscalene block. A randomized controlled trial. Anesthesiology. 2019;131:521-33.
8. da Cunha DF, et al. Incidence of hemidiaphragmatic paralysis in superior trunk versus interscalene block upper limb surgeries: a systematic review, meta-analysis, and trial sequential analysis. Anesthesia and Pain Medicine. 2026.
9. Schöll, et al. Feasibility and adoption of low-volume ultrasound-guided superior trunk block for shoulder reduction in the emergency department. Journal of Clinical Medicine. 2026;15:6245.
10. Galluccio F, et al. Evaluation of interfascial plane and pericapsular nerve blocks to the shoulder joint: a preliminary analysis of shoulder anterior capsular block. Pain and Therapy. 2021;10:1741-54.

Read the free Wavelength Pearl on this topic