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

Area of Science:

• Anesthesiology
• Surgical Oncology
• Regional Anesthesia

Background:

• Regional anesthesia (RA) is increasingly utilized in head and neck surgery for perioperative analgesia.
• Ultrasound-guided RA (UGRA) is favored for opioid-sparing multimodal regimens and enhanced recovery after surgery (ERAS).
• Existing evidence is heterogeneous, necessitating synthesized clinical guidance.

Purpose of the Study:

• To review the literature on the role of RA in head and neck surgery.
• To summarize anatomical basis, techniques, clinical applications, outcomes, and implementation strategies for RA.
• To identify gaps in current research and suggest future directions.

Main Methods:

• Narrative review conducted according to the SANRA framework.
• Comprehensive literature search of PubMed/MEDLINE, Scopus, and Cochrane Library (Jan 2000 - Oct 2025).
• Inclusion of studies on anatomical basis, RA techniques, outcomes, and implementation.

Main Results:

• Superficial cervical plexus block (SCPB) consistently reduces postoperative pain, opioid consumption, and length of stay, particularly after thyroidectomy.
• UGRA improves precision and safety, reducing risks like phrenic nerve paresis, though deeper or bilateral blocks may pose higher risks.
• Evidence is limited by small, heterogeneous trials, variable protocols, and lack of data in complex oncologic or reconstructive settings.

Conclusions:

• RA is a safe and effective adjunct for short-term analgesia and improved perioperative recovery in head and neck surgery.
• Standardized training programs, institutional protocols, and outcome auditing are crucial for successful UGRA implementation.
• Large-scale, standardized trials are needed to clarify RA's role in complex cases and establish best practices for training and clinical integration.