ULTRASOUND-GUIDED REGIONAL ANESTHESIA: ADVANCES, SAFETY, AND EMERGING TECHNIQUES (2020–2026)
Keywords:
ultrasound-guided regional anesthesia; peripheral nerve block; fascial plane block; regional anesthesia; ultrasound; patient safety; local anesthetic systemic toxicity; artificial intelligence; microultrasound; perioperative analgesia.Abstract
Background: Ultrasound-guided regional anesthesia (UGRA) has become an established component of contemporary perioperative care. Between 2020 and 2026, advances in ultrasound imaging, fascial-plane techniques, needle visualization, local anesthetic strategies, education, and artificial intelligence (AI) have expanded its clinical applications. Objective: This review summarizes major advances in UGRA from 2020 through 2026, with emphasis on clinical effectiveness, safety, emerging techniques, and technology-assisted practice.
Methods: A narrative literature review was developed from recent peer-reviewed evidence indexed in major biomedical databases, with emphasis on PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library. Publications from January 2020 through August 2026 were prioritized, including systematic reviews, meta-analyses, randomized and observational studies, narrative reviews, and technology-focused studies.
Results: Recent literature supports the use of UGRA as an important component of multimodal analgesia and enhanced recovery. Fascial-plane blocks, including erector spinae plane, quadratus lumborum, transversus abdominis plane, serratus anterior, pectoral, and other interfascial approaches, have broadened the range of procedures amenable to regional analgesia. Evidence also supports opioid-sparing effects for selected procedures, although comparative efficacy varies by block and surgical population. Safety depends on accurate sonoanatomical interpretation, continuous needle-tip visualization, appropriate local-anesthetic dosing, monitoring, and preparedness for local anesthetic systemic toxicity. High-definition and microultrasound technologies may improve visualization of fascicles and tissue compartments. AI-assisted image interpretation and needle guidance are emerging rapidly, but clinical validation, standardization, dataset diversity, and outcome-based evidence remain limited.
Conclusion: UGRA has progressed from ultrasound-assisted nerve localization toward increasingly precise, anatomy-informed, and technology-supported regional anesthesia. Future research should prioritize clinically meaningful outcomes, standardized reporting, safety surveillance, training, cost-effectiveness, and rigorous evaluation of AI and advanced ultrasound technologies.
