Regional Anesthesia Techniques for Postoperative Pain Management

Regional anaesthesia techniques have become central to the management of postoperative pain by targeting specific nerves or fascial planes to provide effective analgesia whilst minimising systemic opioid requirements. Methods such as epidural analgesia, paravertebral blockade and newer interfascial plane blocks—including the erector spinae plane and pectoral nerve blocks—afford site-specific neural blockade. These approaches reduce pain scores, decrease opioid consumption and facilitate early mobilisation, with a concomitant reduction in side-effects such as nausea, vomiting and urinary retention. Advances in ultrasound guidance have enhanced the precision and safety of needle placement and injectate spread, enabling reproducible outcomes across a range of surgical disciplines from thoracic to abdominal and orthopaedic procedures. Epidemiological and mechanistic studies underscore the global impact of optimised regional techniques in reducing hospital stays and the risk of chronic postsurgical pain.

Research from Nature Portfolio

Recent trials have investigated the visceral analgesic efficacy of interfascial plane blocks. In a randomised, controlled study, bilateral ultrasound-guided erector spinae plane block at the thoracic level significantly reduced intraoperative remifentanil requirements and 24-hour postoperative fentanyl consumption compared with controls receiving only somatic blockade. Patients receiving the plane block also reported lower pain severity in the early postoperative period, suggesting that this technique may confer both somatic and visceral pain relief and could serve as a standalone modality for comprehensive postoperative analgesia.

Regional Anesthesia Techniques for Postoperative Pain Management publication trend

The graph below shows the total number of articles in regional anesthesia techniques for postoperative pain management across all publications each year (not limited to Nature Index journals).

Technical terms

Interfascial plane block: A technique involving injection of local anaesthetic between muscular or fascial layers to target adjacent nerve branches.

Erector spinae plane block (ESPB): An ultrasound-guided interfascial block depositing anaesthetic deep to the erector spinae muscle to achieve dorsal and ventral nerve root analgesia.

Paravertebral block (PVB): Local anaesthetic injection adjacent to the vertebral bodies to block spinal nerve roots unilaterally.

Pectoral nerve block type II (PECS II): An ultrasound-guided plane block targeting the pectoral and intercostobrachial nerves for breast and axillary surgery analgesia.

Epidural analgesia: Continuous infusion of anaesthetic into the epidural space to provide multilevel neuraxial blockade.

References

1. Does Erector Spinae Plane Block Have a Visceral Analgesic Effect?: A Randomized Controlled Trial. Scientific Reports (2020).
2. Comparison of the median and intermediate approach to the ultrasound-guided sacral erector spinae plane block: a cadaveric and radiologic study. Korean Journal of Anesthesiology (2023).
3. The effect of ultrasound-guided erector spinae plane block on postsurgical pain: a meta-analysis of randomized controlled trials. BMC Anesthesiology (2020).
4. A Comparison of the Analgesia Efficacy and Side Effects of Paravertebral Compared with Epidural Blockade for Thoracotomy: An Updated Meta-Analysis. PLOS ONE (2014).