Regional Anesthesia and Nerve Blocks: Analgesic Benefit, Case Selection and Practice Requirements

Regional techniques span peripheral nerve blocks — shoulder, knee, breast, abdominal wall — and neuraxial spinal and epidural anesthesia. For a practice their value is measured in analgesic quality, opioid consumption, and the workflow each technique requires.

Analgesic benefit and opioid sparing

Used alone or alongside general anesthesia, appropriately selected regional techniques can improve postoperative pain control and reduce opioid requirements; the duration of pain relief varies with the technique, the medication, the dose and the use of a catheter. Enhanced recovery pathways use procedure-specific multimodal analgesia, which may include regional techniques and non-opioid medications.¹

What the 2026 ASA guideline establishes

The ASA's January 2026 practice guideline on perioperative pain management using local and regional analgesia is the first US guideline to grade these techniques by procedure rather than in general. For adults it strongly recommends fascial plane blocks to reduce pain and opioid requirements in the first 24 hours after open cardiothoracic, abdominal, retroperitoneal and pelvic surgery and after mastectomy, recommends them after minimally invasive abdominal procedures, and conditionally recommends them for minimally invasive cardiothoracic surgery and open hernia repair; for children it strongly recommends fascial plane blocks after open cardiac or thoracic surgery.³ Fascial plane blocks anesthetize the tissue planes of the chest or abdominal wall rather than a named nerve, which is why their analgesic profile differs from a limb block and why the task force graded them separately — while noting that its analysis was limited by low methodologic quality, inconsistent outcome measurement and small sample sizes.³ For a practice the conclusion is not that blocks belong in every case, but that the block menu should match the procedures actually performed and be written into the analgesia pathway rather than improvised per patient.

Ultrasound guidance

Ultrasound guidance permits direct visualization of the target nerve, needle position and local-anesthetic spread. It does not remove the need to select dose and volume for the specific block and patient, and it does not by itself determine the duration of analgesia.

Antithrombotic therapy and block timing

Antithrombotic and antiplatelet therapy is the main scheduling constraint on neuraxial and deep block placement. The American Society of Regional Anesthesia and Pain Medicine publishes evidence-based guidelines on when these drugs should be paused before and resumed after a block.² The referring practice should supply a complete medication list at preanesthesia evaluation and coordinate any interruption of prescribed therapy with the prescribing clinician and Dr. Seitz before the block is scheduled.

Sources

1. Joshi GP, Kehlet H. Postoperative pain management in the era of ERAS: an overview. Best Pract Res Clin Anaesthesiol. 2019;33(3):259–267.
2. Kopp SL, Vandermeulen E, McBane RD, Perlas A, Leffert L, Horlocker T. Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine evidence-based guidelines (fifth edition). Reg Anesth Pain Med. Published online 2025. doi:10.1136/rapm-2024-105766.
3. Joshi GP, Mariano ER, Elkassabany NM, et al. 2026 American Society of Anesthesiologists practice guideline on perioperative pain management using local and regional analgesia for cardiothoracic surgeries, mastectomy, and abdominal surgeries. Anesthesiology. 2026;144(1):19–43.