Regional Anesthesia in Low- and Middle-Income Countries: Current Landscape and Future Directions

Regional anesthesia (RA) is increasingly promoted as a strategy for expanding safe surgical and obstetric anesthesia access in low- and middle-income countries (LMICs), where general anesthesia (GA) carries disproportionate risk. This review examines current RA utilization patterns, recent advances in training and implementation, persistent barriers, and the evidence linking RA to clinical outcomes in LMICs, in order to identify what is needed for durable, system-wide scale-up.

Large observational analyses show lower perioperative and maternal mortality with regional or neuraxial anesthesia compared with GA. Hybrid training models combining online instruction, simulation, and mentored clinical practice have improved provider knowledge and peripheral nerve block competence, and portable ultrasound has expanded point-of-care applications. However, workforce shortages, inconsistent equipment and medication supply, limited capacity to manage local anesthetic systemic toxicity, and fragmented, single-center safety data continue to constrain reliable implementation. RA offers a safe, lower-resource alternative to GA in LMICs, but sustainable expansion depends on addressing underlying workforce, supply, and monitoring deficits rather than isolated procedural training. Embedding RA within National Surgical, Obstetric, and Anesthesia Plans, supported by multicenter outcome registries and economic evaluation, should guide future research and implementation efforts.