Block It Like It’s Hot

Our star-studded guest list continues live from the GE Healthcare Block Box at ASRA Spring 25! In this episode we interview Ed Mariano, Eleni Moka, and Michael Bullock, and get their answers to such questions as: What platforms work best for social media? How do we bring RA education to under-resourced parts of the globe? What is the mechanism of tourniquet hypertension and what's a clever trick to obviate that? Why is Jeff so $&*# at accents? And more! No cuts, no edits, no bleeps -- just hard-hitting investigative journalism and--oh, wait, I'm being told that's not what we do. Either way, enjoy!

Wine, flamingos, and a glass box…this is NOT your typical BILIH episode...Amit and Jeff join you from the ASRA Spring Annual Meeting 2025 in Orlando, Florida, where they recorded live interviews with over a dozen influential thinkers in regional anesthesiology. Join us as we chat and laugh with James Kim, Sandy Kopp and Nadia Hernandez over discussions of POCUS, probe covers, catheters, the NEW anticoagulation guidelines, and much much more!

Clear!!! In the exciting conclusion to our two-parter on blocks in emergency medicine, things get real as the co-hosts debate Arun and Andrew over the ideal block for hip fracture, a slick way to reduce a shoulder dislocation, cheeky femoral blocks, and the role of fascial plane blocks in the ED.    Links:   The sponsor of this episode is GE Healthcare Venue Family of Ultrasound Machines: https://tinyurl.com/gehealthcarevenue   Article on spontaneous reduction hip dislocation after PENG block: https://pubmed.ncbi.nlm.nih.gov/39781033/   Blockheads website: www.blockheads-em.com   5 Minute Sono: https://coreultrasound.com/5ms/   POCUS Atlas: https://www.thepocusatlas.com/      

Amit and Jeff are joined by Dr. Robbie Erskine from Daaaarrby, UK, sharing his immense wealth of knowledge and experience (and which Bond film is his fave) on spinal anesthesia technique and how to make ambulatory spinals work for everyone!    Remember to email: info@pajunk.com and put "BILIH" in the subject line to receive a free set of Block Guru posters!   Link to the BJA Education article on neuraxial anesthesia in patients with challenging anatomy: https://www.bjaed.org/article/S2058-5349(23)00154-3/fulltext   Link to Robbie's review article on ambulatory spinal anesthesia:   https://www.bjaed.org/article/S2058-5349(19)30107-6/fulltext  

Amit and Jeff are joined by two Emergency Medicine experts (and self-described Blockheads!) with a passion for keeping injured patients comfortable. Drs. Arun Nagdev and Andrew Goldsmith talk to us about the role of regional anesthesia in the ER, what blocks are high-impact, what exactly is meant by a "tube and lube rotation" for trainees, and more!    Link to the JAMA paper on regional anesthesia in the ER and complications: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2826105    

In part 2, Amit and Jeff tackle probe positioning, needle trajectory and something called Pawa's Pleural Groan...Why is the PVB poised to have a renaissance? Should we block one level? Every level? What's the risk of pneumothorax and should this block be done in anti coagulated patients? (spoiler: 2 out of 2 hosts say YES!) Join us for all this and more as we round out this in-depth discussion into one of our FAVE block techniques. Oh, and jokes. Always the jokes. Link to the Cho study on paravertebral micro-CT anatomy: https://pubmed.ncbi.nlm.nih.gov/33990438/   Link to the paper on intermittent bolus vs continuous infusion for PV catheters: https://pubmed.ncbi.nlm.nih.gov/30674696/  

In this episode, Amit and Jeff hold court while discussing the crown jewel of regional techniques, the paravertebral block. Join us for some controversies, debates and jokes while we give paravertebral anatomy and block technique the royal treatment.

Grab an eggnog & a mince pie or two and join Amit and Jeff for a frosty and festive finale to Season 2, featuring answers to some listener questions and a joyful round of dad jokes!   Links to things discussed:   University of Florida study on intercostobrachial nerve block: https://pubmed.ncbi.nlm.nih.gov/35308761/   Good paper explaining how regional anesthesia does NOT block ischemic pain: https://pubmed.ncbi.nlm.nih.gov/24102987/   Puzzling paper attributing acute compartment syndrome after tibial shaft fracture to a femoral nerve block: https://pubmed.ncbi.nlm.nih.gov/8636198/   RAUK algorithm for managing nerve injury: https://www.ra-uk.org/index.php/12-guidelines/266-ra-uk-algorithm-for-management-of-nerve-injury-associated-with-regional-anaesthesia   Sternal hematoma block with catheter: https://pubmed.ncbi.nlm.nih.gov/16988309/   Paper on rebound pain (it's not a thing btw): https://pubmed.ncbi.nlm.nih.gov/33390261/      

In this engaging conclusion of our two-parter, we continue to share some laughs with the amazing Tanya Selak while discussing the value of SoMe collaboration, how to set boundaries when things get rough, and why she's NOT quitting Twitter (X) quite yet. In the meantime, Amit quotes Vanilla Ice, while Tanya seeks redemption as she gets another shot at the Dad-joke title.

Dope beats & phat lyrics...just two audacious dad MCs sharing the podcast origin story over some laid back West-coast flow. 

Amit and Jeff welcome special guest Tanya Selak from Wooleng....Woolloongo....from Australia. Tanya shares her ideas on the role of regional anesthesia in contemporary practice, how and who we should be training procedural skills in anesthesia, and possibly wins the joke-off with the lads. 

In the exciting conclusion of our abdominal wall block series, Amit and Jeff dive into QL blocks (and more!)...what's the deal with QL 1, 2 & 3? Does it REALLY get the whole abdomen? What is a Tequila block and how can I get one cuz it sounds delicious!? Join us for all this and a heapin' helping of the usual dad jokes...   Link to Jeff's QL video: https://youtu.be/vrQ613SoQvI?si=tFzNdjNULvXbFkd_   Link to Amit's ESP video: https://youtu.be/EJDBnzOfmms?si=QnDGjxTWzuffW0gP  

Is it advantageous to mix local anesthetics? Should we perform blocks in asleep patients? Why is the 'tucked vs untucked' scrub debate so fierce?

Join Amit and Jeff for a continuing discussion on belly blocks--we take a deep dive on external oblique intercostal block, find out WHY rectus sheath block is just so darn easy and fun to do, and entertain offers of tummy massages...   Link to External Oblique Intercostal Block video: https://youtu.be/EftwBnMVHOI?si=RC_ARcjCq0fuIGA1   Link to rectus sheath block videos: https://youtu.be/8jZG-w94srQ?si=wKUZbwn0zlztNSdl https://youtu.be/De1hjejTLBY?si=5pDKU_xAW62KJ5Wi   Article on surgeon's attitudes towards regional anesthesia: https://pubmed.ncbi.nlm.nih.gov/15105236/ Article on rectus sheath vs. thoracic epidural: https://pubmed.ncbi.nlm.nih.gov/26414363/ Good salmon recipe: https://tinyurl.com/mr3rd49e  

Amit & Jeff are joined by special guest star Jonny Wilkinson from Northampton as we discuss the role of nerve blocks in the intensive care unit: Which blocks? Who does them? Which patients benefit? How do we best teach these? Laughs were had, sound effects were shared, but no possums were injured in the making of this episode.   The Northampton Critical Care site: https://criticalcarenorthampton.com/  

Rectus, subcostal and TAP...oh my! In this episode, Amit and Jeff tackle belly blocks, and discuss anatomy, clinical decision-making, and their own tips learned the hard way for how to make the most out of abdominal fascial plane blocks. 

Your patient had a latte six hours ago...is their stomach empty? BUT IS IT? Don't fret...there's a quick way to find out and in this tasty episode, Amit and Jeff digest the ins and outs of gastric point of care ultrasound (POGUS), answer some listener questions and compare finger injuries... Links discussed in this episode: Jeff's Gastric Pocus video: https://www.youtube.com/watch?v=4Kc5qVMGGPU Cieslak article: https://pubmed.ncbi.nlm.nih.gov/32234201/ Baettig article: https://pubmed.ncbi.nlm.nih.gov/37587543/ History of fasting guidelines article (gastric fistula observation!): https://pubmed.ncbi.nlm.nih.gov/17080690/  

Amit and Jeff continue their tour of the upper limb, focusing on blocking the distal branches around the elbow, forearm and wrist. Also in this episode: discussion of listener questions about LAST, sharing of failed block stories, and somehow, weirdly, a reference to Paris Hilton.

Amit and Jeff take a tour of the brachial plexus, offering insights, stories, tips and "hold-nothing-back" hot takes regarding best blocks for the upper extremity. 

In this Season 1 festive finale, Amit and Jeff round out the year by reflecting on previous fave moments from the podcast, answer some listener questions, and count down the 12 days of Block-mas...Happy Holidays!

What's in a name? That which we call iPACK by any other name would...well, actually, we're not sure. In this controversial episode Amit and Jeff debate (and disagree!) about proper naming conventions, the value of eponyms, and who has the right to name blocks. Stay tuned for CAPS, PECS, RAPTIR, SPANK, and more...

Amit & Jeff dive into blocks for shoulder surgery, going deep on innervation and exploring a variety of techniques to keep your shoulder patients happy and pain-free. Plus some shout outs, listener questions and a return of the word "gumph" (feel free to suggest alternative spellings...).

Amit & Jeff are back to dissect (yes, intended) the amazing lineup of speakers, talks, workshops and live demos at the 2023 RA-UK Annual Scientific Meeting that was held in Newcastle, UK in May. Couldn't make it but want to hear the highlights? Want to know who won the long-awaited pro-con debate? Ok, ok, we'll leave that one to you to decide...but tune in to hear our thoughts on the rest of the exciting meeting!   Links: RA-UK Meetings website: https://www.ra-ukmeetings.com Amit & Jeff's pro-con debate on the value of nerve stimulation: https://www.youtube.com/watch?v=oRiPOnX_cWs  

What's the best source for RA education? Are textbooks dead? Is it all YouTube and Insta? What about live scanning and cadaver labs? In this episode, Part two of our three-part series on education and teaching, Amit and Jeff discuss the best methods for imparting regional anesthesia wisdom (ironic, given the hosts) in 2023. No jellies were harmed in the making of this episode. 

Teaching regional anesthesia knowledge and skills is a huge and rewarding part of our practice. This episode is the first in a special three-part series aimed at discussing how best to educate the next generation of regional anesthesiologists. Oh, and the usual tomfoolery, accents and jokes.

Is PVB the answer? Or does PECS suffice? Do we need to get the anterior cutaneous branches? How about the axilla? In this episode, Amit & Jeff discuss how to provide top-notch anesthesia and analgesia for breast surgery, including a step-by-step, how-to recipe for awake mastectomy cases. Featuring a special guest appearance by Holt Gadsden!

Hips don't lie, and Amit & Jeff are here to tell the truth (or at least...share their unvarnished thoughts) about how best to provide anesthesia and analgesia for hip arthroplasty. Whether you're a fan of spinal, GA, lumbar plexus, QL or PENG, there's something for everyone in this episode to keep us true to our hip-ocratic oath to keep patients safe and comfy.

We. Love. Tech. And all the fun gadgets and cool pieces of cutting-edge equipment that make learning, teaching and practicing regional anesthesia fun and safe. In this episode, Amit & Jeff discuss the innovative and useful bits of gear that they use in their practice, as well as several more that they can't wait to get their hands on.

Femoral triangle vs. adductor? iPACK vs. surgical infiltration? Wait...geniculars, what?! In this episode, Amit & Jeff discuss ALL the ways to keep total knee patients comfortable while reducing side effects and getting these patients moving and out the door. Listen in to hear the anatomic basis for why we do these blocks and some tips and tricks for making them work for you.

Are you an ESP lover or hater? In this episode, Amit and Jeff discuss all things erector spinae plane block and manage to touch on mechanisms, the controversy about ventral spread, which surgical procedures it works best for, and most importantly, share some tips and tricks to make sure that it DOES work for you in your practice. 

In our inaugural episode, Amit and Jeff learn a little bit about each other's backgrounds (amongst other things such as movies, Disney and fave Xmas foods) and discuss what we can expect from the podcast going forward.