Regional Anaesthesia Approaches in Head and Neck Surgery: Current Evidence and Clinical Applications

General approaches of head and neck surgery involve varied procedures with developing perioperative care and a renewed effort on regional anaesthesia (RA) for intraoperative and postoperative analgesia. Due to the rich innervation and focus on enhanced recovery after surgery (ERAS), RA techniques, particularly ultrasound-guided ones, are becoming popular as part of an opioid-sparing multimodal analgesic regimen. However, the evidence base is heterogeneous and synthesised clinical guidance is needed. This narrative review, performed according to the Scale for the Assessment of Narrative Review Articles (SANRA) framework, summarises the existing literature on the role of RA in head and neck surgery, including anatomical basis, types of techniques used for RA, clinical applications, immediate outcomes and implementation. We conducted a comprehensive literature search, including studies published between January 2000 and October 2025 in English, across the PubMed/MEDLINE, Scopus, and Cochrane Library databases. Understanding of the anatomy of cervical plexus (C1-C4) and cranial nerves such as trigeminal V is basic to delineation of techniques into superficial (e.g., SCPB), deep and selective cranial nerve blocks. The evidence about decreases in postoperative pain intensity, opioid consumption (especially 24 h post-op) and decreased length of stay, largely through studies on thyroidectomy, has been consistent for SCPB as an adjunct to general anaesthesia. Ultrasound-guided regional anaesthesia (UGRA) has significantly enhanced precision and safety, reducing risks such as phrenic nerve paresis, although the concern for even higher complication rates remains with deeper or bilateral blocks. Although beneficial outcomes have been demonstrated, the literature is plagued by small and heterogeneous trials, variable block protocols, and a lack of data in complex oncologic resections or reconstructive settings. For successful implementation, there is a need for structured training programmes of anaesthesiologists and surgeons involved in the procedure performing UGRA together, institutional protocols on standardised technique, patient monitoring and outcomes auditing. RA is a useful and safe adjunct to head and neck surgery, providing analgesia in the short term and contributing to improved recovery during the perioperative period. Further studies should be conducted through large-scale, standardised trials to resolve the contributions of blocks in complex surgical cases and implement best practices for both training and clinical integration.