Regional Anesthesia Techniques Research Articles

IPACK Block and Adductor Canal Catheter vs Adductor Canal Catheter for Total Knee Arthroplasty: A Randomized Controlled Trial

Background: Regional anesthetic techniques including the adductor canal catheter (ACC) have aided management of post-operative pain for total knee arthroplasty (TKA). The interspace between the popliteal artery and posterior capsule of the knee (iPACK), has been introduced to address posterior knee pain that is not well covered by the ACC. Studies have looked at the addition of the iPACK block to subjects who received an ACC with and without periarticular local infiltration with varying results. We hypothesized that adding the iPACK block to subjects who also received an ACC and periarticular injection (PAI) would significantly decrease opioid consumption compared to the ACC alone in TKA. Methods: Sixty subjects were randomized to receive an ACC alone (control group) or ACC plus single shot iPACK block (iPACK group) for TKA. All subjects were operated on by the same surgeon and received the same PAI. For the primary outcome of postoperative pain, we used opioid consumption as measured by morphine milligram equivalent (MME). Secondary outcomes included pain scores determined by the visual analog scale (VAS), distance ambulated, time to physical therapy (PT) and length of hospital stay. Results: We did not observe a significant difference between groups for opioid consumption, pain scores, distance ambulated (p > 0.05 across all time points), length of hospital stay (p = 0.64), or time to PT (p = 0.32). Conclusion: When combined with an ACC and PAI, the iPACK block did not significantly decrease opioid consumption, pain scores, time to first PT session or increase distance ambulated.

Regional anaesthetic techniques in 14 Slovenian obstetric units between 2013 and 2021: where are we and where are we going?

Background: The use of regional anaesthetic techniques for caesarean section and labour analgesia is necessary for quality-driven obstetric anaesthesia as required by European minimum standards for obstetric analgesia and anaesthesia departments, which were issued by the European Society of Anaesthesiology and Intensive Therapy in 2020. The aim of this article is to evaluate the rate of caesarean sections performed using regional anaesthetic techniques and the rates of epidural, remifentanil-PCA, and meperidine analgesia for managing labour pain across the 14 Slovenian obstetric units, respectively. Methods: Data from the Slovenian National Perinatal Information System (NPIS) from 2013 to 2021 were analysed. Results: Spinal anaesthesia was used as a primary anaesthetic method (> 50% of elective caesarean sections) in a half of Slovenian obstetric units. For emergency caesarean sections, regional anaesthetic methods (spinal and epidural) were used in > 50% parturients in 3 obstetric units. Eight obstetric units had an epidural rate of >10%. The use of epidural analgesia has progressively increased in 9 of 14 obstetric units. Remifentanil has been routinely used in 6 obstetric units. Accordingly, the consumption of meperidine has dropped in all but one obstetric unit in Slovenia. Conclusion: In the past decade, considerable progress has been observed in obstetric anaesthesia practice in Slovenia. This is evident from the increased use of regional anaesthesia for caesarean section and labour analgesia. However, there are considerable discrepancies in anaesthetic practices between different obstetric units in Slovenia, a situation the parturients should be informed of well in advance to be able to choose the obstetric unit according to their labour and delivery preferences. In order to avoid the differences in the quality and accessibility of anaesthetic practice between units, it is necessary to increase the number of anaesthesiologists involved in obstetric anaesthesia to ensure 24/7 service of labour analgesia to be able to fulfill minimum European standards for obstetric analgesia and anaesthesia departments.

Can Rhomboid Intercostal Block Be an Alternative to Paravertebral Block in Video-Assisted Thoracoscopic Surgery? A Randomized Prospective Study.

Rhomboid intercostal block (RIB) is a new interfascial plane block. RIB is a simple and clinically effective technique. Paravertebral block (PVB) is offered as a first-line regional anesthesia technique for thoracoscopic surgeries. In this study, we aim to compare the analgesic efficacy of RIB to PVB in video-assisted thoracoscopic surgeries (VATSs). This is a prospective randomized study with 84 patients aged 18-75 and ASA I-III, undergoing VATS for primary lung cancer. The study was approved by an ethical committee and registered under clinicaltrials.org. With informed consent, patients were randomized to receive ultrasound-guided RIB or PVB at T5-level with 20 mL of %0.25 bupivacaine preoperatively. Surgeries were performed under general anesthesia. Postoperatively, patient-controlled IV fentanyl analgesia was prescribed, delivering 10 μg boluses upon request with 10 min of a lock-out period. Patients received paracetamol 1 g IV three times a day and tramadol 50 mg IV for breakthrough pain. The postoperative Numeric Rating Scale (NRS) for pain, total opioid consumption, and rescue analgesic requirements were recorded postoperatively at 1, 3, 6, 12, and 24 h. There were no significant differences in 24 h total opioid consumption between the RIB and PVB groups [PVB: 48.5 (39.5-55) mcg; RIB: 48.6 (40.2-65) mcg; p = 0.258], nor in rescue analgesic requirements [PVB: seven patients (20%); RIB: seven patients (17.1%); p = 0.570]. NRS pain scores were also similar between the groups, with no significant difference in overall pain control efficacy (p = 0.833). RIB is comparable to PVB in analgesic efficacy for VATS and can be considered as an alternative analgesic modality.

Continuous Catheter Techniques Versus Single-Injection Nerve Blocks: A Comprehensive Review of Postoperative Pain Management Strategies.

Effective postoperative pain management is crucial for optimizing patient recovery and enhancing surgical outcomes. This review compares two prominent regional anesthesia techniques, continuous catheter techniques and single-injection nerve blocks, focusing on their efficacy, safety, and impact on patient outcomes. Single-injection nerve blocks involve administering a one-time anesthetic dose to a specific nerve or plexus, offering immediate but transient pain relief. In contrast, continuous catheter techniques utilize a catheter to deliver a continuous infusion of anesthetic, providing extended analgesia. The review synthesizes current evidence on the effectiveness of each method, highlighting that single-injection blocks are advantageous for their simplicity and rapid onset but may require supplementary pain management for longer procedures. Continuous catheter techniques, while offering prolonged pain relief, carry risks such as infection and catheter displacement. The comparative analysis of these techniques reveals that both have distinct roles in postoperative care, with choice depending on the surgical procedure and patient needs. Patient satisfaction, recovery times, and overall outcomes are critical factors in determining the optimal pain management strategy. Future research should focus on refining these techniques and exploring innovations to improve patient care and pain management outcomes. This review provides insights for clinicians to make informed decisions about postoperative pain management to enhance patient comfort and recovery.

The Role of Regional Anesthesia in Reducing Postoperative Pain in Pediatric Patients

Introduction: Ensuring adequate analgesia is crucial for minimizing morbidity and healthcare costs, ultimately enhancing the success of ambulatory surgery outcomes. The purpose of this study was to evaluate the effectiveness of regional anesthesia in reducing postoperative pain in pediatric patients. Aim of the study: The aim of this study was to evaluate the effectiveness of regional anesthesia in reducing postoperative pain in pediatric patients. Methods: This prospective observational study included 60 pediatric patients who underwent various surgical procedures with regional anesthesia at the Department of Anaesthesia, Analgesia, and Intensive Care Medicine, BSMMU, Dhaka, Bangladesh, from January 1, 2022, to December 31, 2023. Patients aged < 15 years were included, with baseline pain scores recorded preoperatively and postoperative pain levels assessed at 1, 3, 6, 12, and 24 hours. Data on regional anesthesia techniques and pain scores were analyzed using SPSS version 22.0. Result: The study revealed that the largest group of pediatric patients were aged 7–14 years, with regional anesthesia techniques like upper and lower limb blocks being the most common. Postoperatively, 33.33% of Neonates and Infants reported a pain score of 0 within the first 3 hours, while nausea and postdural puncture headache (PDPH) were observed in 25.00% and 13.33% of patients, respectively. Most patients had a hospital stay of 4–6 days, though 21.67% required more than 10 days. Conclusion: Regional anesthesia effectively reduced postoperative pain in pediatric patients, demonstrating significant pain management benefits, minimal complications, and a positive impact on recovery and hospital stay duration.

Pediatric Charcot-Marie-Tooth disease and peripheral nerve blocks:a retrospective cohort study of 25 patients.

Charcot-Marie-Tooth (CMT) disease is an inherited neurologic disorder characterized by progressive peripheral neuropathies. The use of peripheral nerve blocks (PNB) in patients with CMT disease has been controversial because of concerns about exacerbating existing neurologic impairments and the "double hit" hypothesis. We aimed to assess the use of PNB in pediatric patients with CMT disease undergoing orthopedic surgery to address the limited data available in the literature on this topic. In this retrospective cohort study, we included all pediatric patients with CMT disease scheduled for orthopedic surgery receiving PNB at our centre. All of the patients had preoperative neurologic exams and received one or more ultrasound-guided regional anesthesia techniques. Data extracted included details of anesthesia technique, surgical procedure, opioid consumption, and pain scores during the first three postoperative days. We also reviewed any complications such as neurologic deficits and local anesthetic toxicity. We used descriptive statistics to summarize the findings. We included 25 patients, 14 of whom (56%) presented with pre-existing neurologic deficits, primarily in the lower extremities. Postoperative assessments revealed no new neurologic impairments in 24/25 (96%) patients, with only one patient experiencing a nerve injury possibly related to the surgical procedure. Opioid consumption was low in the postanesthesia care unit and on the day of surgery. No additional complications were noted in the first 72hr after surgery. Despite concerns, PNB showed favourable outcomes in a pediatric cohort with CMT disease, with low opioid consumption and pain scores and minimal complications during follow-up. These findings match previous reports of adult patients with CMT disease and suggest that the benefits of PNB may outweigh the perceived risks in pediatric patients with CMT disease.

Efficacy of perioperative pain management in paediatric cardiac surgery: a protocol for a network meta-analysis

IntroductionCongenital heart disease is a common birth defect, but advancements in diagnosis and treatment have improved survival rates. Enhanced recovery after surgery (ERAS) programmes have emerged in paediatric cardiac surgery....

Comparative Effectiveness of Regional Anesthesia and Nerve Block Techniques in Reducing Chronic Post-Surgical Pain in Adults Undergoing Inguinal Hernia Surgery: A Systematic Review

Background: This study to show about comparative effectiveness of regional anesthesia and nerve block techniques in reducing chronic post-surgical pain in adults undergoing inguinal hernia surgery. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. Result: Eight publications were found to be directly related to our ongoing systematic examination after a rigorous three-level screening approach. Subsequently, a comprehensive analysis of the complete text was conducted, and additional scrutiny was given to these articles. Conclusion: CPSP is a multifactorial and complex condition that can significantly affect the quality of life of patients undergoing surgery. General anesthesia plus ilioinguinal nerve block is better than spinal anesthesia (SA) regarding postoperative analgesia, time to mobilization and discharge, side-effect profile and satisfaction experienced by the patients. Regional block anesthesia (RBA) is superior to conventional spinal anesthesia (CSA) for pain relief at 24 hours post-surgery.

Impact of Dexamethasone on Lignocaine and Ropivacaine Mixture for supraclavicular Brachial Plexus Block: A Prospective, Randomized, Double Blind Trial

Supraclavicular brachial plexus block is a common regional anesthesia technique used for upper extremity orthopedic surgeries. The addition of adjuvants to local anesthetics can prolong the duration of analgesia and improve the quality of the block. This prospective, randomized, double-blind study aimed to investigate the impact of dexamethasone on the efficacy of a lignocaine and ropivacaine mixture for ultrasound guided supraclavicular block. A total of 80 patients scheduled for major forearm orthopedic surgery were randomly assigned to receive either a mixture of lignocaine 2% and ropivacaine 0.5% (control group) Group A or the same local anesthetic mixture with the addition of dexamethasone 8 mg (dexamethasone group) Group B. The primary outcome was the duration of analgesia, defined as the time from block placement to the first request for rescue analgesia. Secondary outcomes included the onset time of sensory and motor block, the quality of the block, and the incidence of adverse events. The results showed that the addition of dexamethasone significantly prolonged the duration of analgesia compared to the local anesthetic mixture alone (135 ± 10 min vs. 170 ± 15 min, respectively, p < 0.001). Addition of dexamethasone to mixture of lidocaine and ropivacaine in supraclavicular block results in prolonged duration of sensory and motor block and also improves quality of analgesia without affecting its onset.

Comparative Study of Injection Butorphanol Versus Injection Fentanyl with Injection Ropivacaine in Ultrasound Guided Supraclavicular Block to Evaluate Sensory and Motor Block Characteristics

BACKGROUND Regional anaesthetic technique has many advantages over general anesthesia. The supraclavicular brachial plexus block due to its rapid onset and reliability offers dense anesthesia of brachial plexus for surgeries at or distal to elbow. The additives like injection Fentanyl and injection Butorphanol along with 0.5% injection Bupivacaine have been proved to be efficient for supraclavicular block. However their effects haven't been compared by using them as additives in 0.5% Injection Ropivacaine. Aims To compare the sensory and motor block characteristics of injection Butorphanol and injection Fentanyl in injection Ropivacaine. METHODS This prospective single blinded randomised control study included 60 patients (ASA I or II; 18- 60 yrs) scheduled for upper limb surgeries. Patients were randomly allocated to two groups of 30 each and supraclavicular block was given as per distribution (Group B: 30 ml 0.5 % injection Ropivacaine with 2mg injection Butorphanol and Group F: 30 ml 0.5 % injection Ropivacaine with 100 mcg injection Fentanyl). The hemodynamic parameters were recorded at baseline, post block and till 45 mins. Sensory and motor block assessments were done along with sedation score determination. Duration of sensory and motor block was noted. RESULTS The group with injection Fentanyl as additive had earlier onset of motor blockade. Time required to achieve sensory blockade was less in Group F. Duration of sensory and motor block prolonged in Group F. CONCLUSIONS Injection Fentanyl as additive in injection Ropivacaine provided earlier onset of motor block and decreased total time required to achieve maximum sensory block with prolonged duration and decreased requirements of rescue analgesia.

A novel and promising regional anesthesia technique in living-donor renal transplantation surgery: Quadro-iliac plane block.

A novel and promising regional anesthesia technique in living-donor renal transplantation surgery: Quadro-iliac plane block.

Multimodal Analgesia Strategies for Cardiac Surgery: A Literature Review

In cardiac surgery, poststernotomy pain is a significant issue, peaking within 48 h and requiring proper analgesia for both acute relief and avoidance of chronicization. Opioids are commonly used for pain management postsurgery but pose risks such as adverse effects and dependency. Post-cardiac surgery pain can stem from various sources—somatic, visceral, and neuropathic—making opioid reliance a concern. Multimodal analgesia, which combines different medications and regional anesthesia techniques, is increasingly recommended to decrease opioid use and its related problems. Strategies include acetaminophen, gabapentinoids, NMDA antagonists, alpha-2 agonists, intravenous lidocaine, anti-inflammatory drugs, and regional anesthesia. These approaches can enhance pain control, reduce opioid reliance, and improve cardiac surgery outcomes. The ERAS® Cardiac Society strongly advocates for an opioid-sparing multimodal approach to improve patient recovery by reducing complications and increasing patient satisfaction. This review aims to consolidate current evidence to assist healthcare providers in customizing pain management for patients post-cardiac surgery, emphasizing reduced opioid use and optimizing the recovery process.

Thoracic segmental spinal anaesthesia a boon in challenging case scenarios: A case series

Thoracic segmental spinal anaesthesia is a regional anaesthesia technique that can strategically serve as an alternative asset to general anaesthesia for certain high-risk cases. The procedure is picking up pace as it is beneficial in maintaining hemodynamic stability for these patients and reducing side effects encountered with general anaesthesia. Segmental Thoracic Spinal anaesthesia is a realistic, reliable, and reasonable anaesthesia technique that can be implemented for abdominal and thoracic surgeries. Additionally, it has fewer postoperative complications and superior patient satisfaction. We would like to discuss 5 case scenarios where TSA were used mode of anaesthesia as they were found to be high risk for GA.

Analgesic efficacy of ultrasound-guided bilateral sphenopalatine ganglion block as a sole analgesic in fess surgeries and reconstructive nasal surgeries

: Severe postoperative pain is the most common complaint following Functional endoscopic sinus surgeries (FESS) and reconstructive nasal surgeries. Sensory, autonomic nerves supplying paranasal sinuses, nasal cavity, and palate relay in sphenopalatine ganglion. Bilateral Sphenopalatine ganglion block can be an effective regional anaesthetic technique for post-operative analgesia. We conducted a study with ultrasound-guided bilateral sphenopalatine ganglion block as the sole analgesic compared to Fentanyl in patients undergoing FESS & reconstructive nasal surgeries performed under general anaesthesia. The primary objective of our study was to assess the analgesic effect, quality, and duration of analgesia of ultrasound guided bilateral sphenopalatine ganglion block as a sole analgesic. In addition, the secondary aim was to further evaluate the adverse effects.With Institutional ethical committee approval and written informed consent, we conducted this study with two groups of 30 patients each. The surgical procedure was performed under general anaesthesia. At the end of the surgery and before the reversal of neuromuscular blockade, bilateral sphenopalatine plexus block was performed under ultrasound guidance in interventional Group (A) with a mixture of 0.25% Ropivacaine, Dexamethasone 4mg 7.5ml each side, whereas the control Group (B) received fentanyl 2ug/kg intraoperatively. Visual analogue scale (VAS) scores were evaluated soon after extubating (0hrs) and up to 48 hrs postoperatively in all patients.There was no significant difference in VAS scores at 0hrs, 2hrs between both groups. Interventional group(A) had statistically significant lower scores (P <0.00) 4hrs onwards till 48hrs than in control group(B). No adverse events were noted with minimal postoperative analgesic requirement in group(A) (P <0.000).: We conclude, that ultrasound-guided bilateral sphenopalatine block is a safe and effective procedure that provides sustained and superior quality of analgesia when compared to fentanyl

Liposomal Bupivacaine via an Adductor Canal Block Compared to a Peripheral Nerve Catheter and No Block After Total Knee Arthroplasty: A Retrospective Analysis.

Background As total knee arthroplasty is one of the most common surgeries in the United States, it is important to identify regional anesthesia methods that optimize patient recovery. This study evaluates the effectiveness of adductor canal (AC) blocks with liposomal bupivacaine (LB) compared to other regional anesthesia techniques. We hypothesized that patients receiving single-shot (SS) AC blocks with LB would have lower postoperative opioid consumption compared to other groups. Methods A retrospective cohort analysis was conducted on patients from a single institution between January 2014 and December 2021. The primary outcome assessed was postoperative opioid use, with secondary outcomes including postoperative pain scores and hospital length of stay. Results The final analysis included 280 patients: 41 received an SS AC block with plain local anesthetic, 76 received a peripheral nerve catheter (PNC) with continuous ropivacaine, 79 received an SS AC block with LB, and 84 received no block. In fully adjusted models, postoperative opioid consumption on day one was significantly lower in the SS AC block with LB group compared to the no block group (b = 23.2, SE = 5.7, p < 0.0001), the PNC group (b = 15.5, SE = 5.7, p = 0.01), and the SS AC block with plain local anesthetic group (b = 18.9, SE = 6.9, p = 0.01). Additionally, hospital length of stay was significantly reduced in the LB group compared to the no block group (b = 1.5, SE = 0.3, p < 0.0001), the PNC group (b = 1.1, SE = 0.3, p < 0.0001), and the SS AC block with plain local anesthetic group (b = 1.5, SE = 0.3, p < 0.0001). Conclusions Patients who received an AC block with LB had higher pain scores on postoperative day 0 (POD0) but required less opioid medication on postoperative day 1 (POD1) and had a shorter hospital stay compared to patients who received other types of AC blocks or no block.

Critical care innovations: navigating pain relief in intensive care: the role of regional anesthesia.

The purpose of this article is to provide an update of regional anesthesia and its applications in the critical care patient population. Regional anesthesia including blocks of the abdomen and thorax, head and neck, as well as upper and lower extremities can be used to alleviate pain and assist in managing life-threatening conditions such as cerebral vasospasm and ventricular storm in the ICU population. There have been many advances in these techniques including ultrasound-guidance with innovative approaches that allow for more superficial procedures that are safer for critically ill patients. Regional anesthesia can decrease hospital length of stay (LOS), prevent ICU admission, shorten ICU LOS, and increase ventilator free days and may have mortality benefits. Pain management in the ICU is an important and sometimes challenging aspect of patient care. Regional anesthetic techniques have more indications and are safe, versatile tools that should be incorporated into care of critically ill patients.

Regional Anesthesia Techniques for Breast Cancer Surgeries—A Narrative Review

Regional Anesthesia Techniques for Breast Cancer Surgeries—A Narrative Review

Comparative Review of Postoperative Analgesic Use After Total Hip Replacement: Opioids Versus Non-opioids.

Total hip replacement (THR) is a common surgical procedure aimed at alleviating pain and improving function in patients with hip joint pathology. Effective postoperative pain management is crucial for patient recovery, satisfaction, and overall outcomes. This narrative review examines the comparative efficacy, safety, and implications of using opioids versus non-opioid analgesics in managing postoperative pain following THR. Opioids, while effective for severe pain, pose significant risks such as addiction, tolerance, and adverse effects. Non-opioid analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and regional anesthesia techniques, offer alternatives with potentially fewer side effects. This review synthesizes current evidence from clinical trials, observational studies, and expert guidelines to provide a comprehensive understanding of the benefits and drawbacks of each analgesic approach. The goal is to inform clinical decision-making and optimize pain management strategies for THR patients, balancing efficacy and safety.

Ultrasound-Guided Fascia Iliaca Block Versus Pericapsular Nerve Group Block Before Positioning for Spinal Anesthesia in Patients Undergoing Surgery for Neck of Femur Fracture: A Comparative Study.

Introduction Positioning patients with femur fractures for spinal anesthesia can be challenging due to pain. Regional anesthesia techniques, such as the fascia iliaca compartment block (FICB) and pericapsular nerve group block (PENG), have facilitated patient positioning and improved analgesia. This study compared the efficacy of ultrasound-guided FICB and PENG for pain management during the positioning of the patient for spinal anesthesia in neck of femur fracture surgeries. Aim of the study Ultrasound-guided fascia iliaca compartment block versus pericapsular nerve group block before positioning for spinal anesthesia in the neck of femur fracture surgeries. Materials and methods This prospective, randomized, single-blinded, and comparative study was conducted at Dr. DY Patil Hospital, Pune, from November 2022 to January 2024 and included 60 patients with neck and femur fractures scheduled for surgery under spinal anesthesia. Patients were randomly assigned to receive either ultrasound-guided FICB (n = 30) or PENG (n = 30) with 0.25% 20 ml of bupivacaine before positioning for spinal anesthesia. The primary outcome was to assess the Visual Analog Scale (VAS) score for pain before and after the block. Secondary outcomes included assessment of hemodynamic parameters, patient satisfaction, and adverse effects. Results The number of days since fracture in FICB was 2.73±0.98 and in PENG was 3.37±1.9 was comparable with no significant difference between them (p-value =0.11). The mean VAS score after the block was significantly lower in the PENG group compared to the FICB group (3.33±1.73 vs. 4.43±1.3, p = 0.007), indicating better pain relief with PENG. Both techniques were comparable in terms of hemodynamic stability. Patient satisfaction was high and similar in both groups. No significant adverse effects were reported. Conclusion This study observed that the ultrasound-guided pericapsular nerve group block was superior to the fascia iliaca block in providing better analgesia, good patient satisfaction, and hemodynamic stability during positioning for spinal anesthesia.

Efficacy and Safety of Obturator Nerve Block in Transurethral Resection of Bladder Tumors: A Comprehensive Review.

Transurethral resection of bladder tumors (TURBT) is a pivotal procedure in the management of bladder cancer, essential for both diagnosis and treatment. Effective anesthesia is crucial in TURBT to ensure a stable and pain-free operative field, facilitate precise tumor resection, and minimize complications such as the obturator reflex, which can lead to involuntary leg movement and bladder injury. The obturator nerve block (ONB) is a regional anesthesia technique designed to prevent the obturator reflex by blocking the obturator nerve, which innervates the adductor muscles of the thigh. This comprehensive review evaluates the efficacy and safety of ONB in TURBT. It begins by discussing the anatomical and physiological aspects of the obturator nerve, followed by a detailed examination of various ONB techniques, including ultrasound-guided and landmark-based methods. The review assesses the impact of ONB on pain management, reduction of adductor muscle spasms, and overall improvement in surgical conditions and patient satisfaction. Additionally, it explores the incidence and types of complications associated with ONB, such as hematoma, nerve injury, and local anesthetic systemic toxicity (LAST). It compares ONB with other anesthesia techniques used in TURBT, such as general, spinal, and epidural anesthesia. A critical analysis of key clinical studies and meta-analyses is presented to provide a comprehensive understanding of the current evidence on ONB efficacy and safety. Future directions and innovations in ONB techniques, including advances in imaging and nerve localization, are also discussed. Practical recommendations for implementing ONB in clinical practice, including guidelines for clinician training and patient selection criteria, are provided. This review aims to inform clinicians about the benefits and risks of ONB in TURBT, guide clinical practice, and identify areas for future research to optimize anesthesia management in bladder cancer surgery.