Regional Blocks in the Era of the Opioid Crisis: Evaluating Their Opioid-Sparing Effect

Perioperative pain management strategies are increasingly shifting towards opioid-sparing approaches due to the ongoing opioid epidemic, with regional anaesthesia contributing significantly to multimodal analgesia. The purpose of this narrative review was to determine if the effect of regional anaesthesia on opioid consumption has been overestimated. Literature searches performed through PubMed, MEDLINE, and Google Scholar identified relevant studies that evaluated perioperative consumption of opioids, postoperative pain, and recovery profiles for neuraxial and peripheral nerve blocks. Current evidence demonstrates that regional anaesthesia significantly reduces opioid requirements and improves pain control in the immediate postoperative period, typically within the first 24-48 hours, while also decreasing opioid-related adverse effects such as postoperative nausea, sedation, and respiratory depression. However, most studies are limited to short-term outcomes, with insufficient evidence supporting sustained reductions in long-term opioid use or prevention of chronic pain. Furthermore, substantial heterogeneity in study design, surgical procedures, and concurrent use of multimodal analgesia complicates the isolation of regional anaesthesia's independent effect, potentially leading to overestimation of its true impact. Additional factors, including rebound pain, limited duration of single-shot blocks, and practical implementation constraints, may further attenuate its clinical benefit. While regional anaesthesia remains an important component of perioperative analgesia, its opioid-sparing effect appears to be context-dependent and best understood as part of a balanced, individualised multimodal approach rather than as a standalone solution.