<p>Managing acute pain in the Emergency Department (ED) is one of the primary roles of an Emergency Physician (EP), but the constraints of using opiate sparing medications provide an additional challenge for EPs to circumnavigate. In an effort to avoid opioids, many EPs have turned to ultrasound-guided nerve blocks (UGNBs), which have demonstrated outstanding analgesia, in addition to a strong safety profile, decreased risk of delirium, and shortened ED lengths of stay. Some of the primary obstacles to performing nerve blocks, however, are institutional barriers, including buy-in from ED leadership and other hospital stakeholders, ensuring appropriate equipment as well as a lack of provider familiarity with UGNBs. Here, we lay out a framework for developing a nerve block program from scratch, which includes highlighting the various stakeholders and their respective roles, how to set up quality assurance monitoring, educational guidelines, and safety measures. As more EPs are performing UGNBs globally, it is imperative for EDs to initiate block programs, and we hope that these guidelines help provide a starting point for such departmental initiatives.</p>