Regional Anaesthesia for painless functional outcomes 

Modern perioperative care aims to use targeted regional anaesthesia (RA) techniques within multimodal, opioid-sparing analgesic strategies to improve functional recovery by optimising pain control while prioritising early mobilisation, reducing hospital length of stay (LOS), and improving quality of life. This approach is especially relevant for trauma, orthopaedic, and abdominal surgeries, where postoperative pain can delay rehabilitation, increase opioid-related side effects, and contribute to persistent postsurgical pain (PPSP).  

Evidence-based frameworks such as the PROSPECT (Procedure-Specific Postoperative Pain Management) guidelines and ERAS (Enhanced Recovery After Surgery) Society recommendations strongly support RA as a cornerstone of these protocols. (1)(2) PROSPECT provides procedure-specific recommendations emphasising fascial-plane blocks, peripheral nerve blocks, and continuous catheter techniques to minimise systemic opioids. ERAS pathways for abdominal/pelvic and orthopaedic surgery similarly integrate RA to reduce surgical stress, preserve physiological function, and speed up recovery. Evidence shows that key benefits include superior analgesia, lower opioid consumption, earlier ambulation, fewer complications, and shorter LOS compared with opioid-based regimens alone. (3) 

In the symposium session “Regional anaesthesia for painless functional outcomes”, the speakers will share their evaluation of multimodal analgesic and regional anaesthesia techniques that support effective pain management and functional recovery in trauma, orthopaedic, and abdominal surgeries. They will analyse evidence-based protocols and patient-specific strategies aimed at promoting early mobilisation and reducing opioid reliance across varied surgical scenarios. The session will explore clinical outcomes and emerging innovations that contribute to a painless, functional recovery, ultimately improving quality of life and shortening hospital stays. 

Dr. Michele Carella is an anaesthetist at CHU Liège, University of Liège, Belgium, with research interests focused on regional anaesthesia for enhanced recovery after orthopaedic surgery, postoperative functional recovery, and patient-reported outcomes. He holds the ESRA Diploma in Regional Anaesthesia (EDRA) and serves on the Board of the Belgian Association for Regional Anaesthesia (BARA). In his presentation on “Orthopaedic surgery”, he will discuss how regional anaesthesia can contribute not only to pain relief but also to painless functional recovery after hip and knee arthroplasty. Using recent clinical trials, he will compare contemporary ultrasound-guided techniques such as supra-inguinal fascia iliaca and pericapsular nerve group (PENG) blocks in total hip arthroplasty, with particular attention to opioid-sparing effects, early mobilisation, and integration into ERAS pathways.  

He will also highlight the growing importance of more patient-centred outcome measures such as PROMs (Patient-Reported Outcome Measures) and PREMs (Patient-Reported Experience Measures), rather than relying exclusively on traditional functional endpoints frequently used in regional anaesthesia studies, which are often centred on isolated motor or muscle performance parameters. This broader perspective may better reflect holistic recovery and modern ERAS objectives. (4)(5)(6) 

RA has a key role in acute trauma pathways, including rib fractures (erector spinae plane block) hip fractures (fascia iliaca block). Evidence points to improved respiratory function, reduced incidents of delirium in elderly patients, and earlier mobilisation. (7) Dr. Gabriella Iohom is a Consultant Anaesthesiologist and Senior Lecturer at the University of Cork, Ireland. She has longstanding expertise in ultrasound-guided RA for ambulatory and trauma orthopaedic surgery, including technique optimisation, patient-centred outcomes, and standardisation of documentation. (8)(9) She has contributed to reviews and consensus statements on RA techniques for upper-limb/ambulatory orthopaedic trauma and on standardised documentation to ensure reproducible, evidence-based practice. (10) In her presentation “Trauma”, she will focus on using RA in acute trauma pathways. She will review ultrasound-guided peripheral nerve blocks, especially for upper-limb trauma, highlighting benefits for ambulatory settings, opioid sparing, and faster functional recovery versus general anaesthesia. She will discuss evidence-based protocols and patient-specific strategies, including the Delphi consensus on effective RA documentation, to promote early mobilisation and standardised care in acute trauma. 

Dr. Dario Bugada is a Consultant Anaesthesiologist at Papa Giovanni XXIII Hospital in Bergamo, Italy. He has extensive clinical and research expertise in opioid-sparing and enhanced-recovery protocols that integrate regional anaesthesia (RA) techniques. He will directly address the use of continuous and fascial-plane RA to improve perioperative outcomes, reduce opioid consumption, and promote functional recovery in his presentation, “Abdominal surgery”. Dr. Bugada will discuss strategies such as transversus abdominis plane (TAP) and rectus sheath blocks, continuous wound infusions, and blended opioid-free anaesthesia protocols for laparoscopic and major abdominal procedures. He will highlight their role in providing superior analgesia, increasing the chances of early mobilisation, shortening hospital stays, and reducing the risk of persistent postsurgical pain. (11) (12)(13) 

The symposium session “Regional anaesthesia for painless functional outcomes” will take place at the Euroanaesthesia Congress 2026 on Saturday, June 6 at 10:30 – 11:30 CEST in room ROTTERDAM A. 

References 

1. https://erassociety.org/guidelines/ 

2. https://esraeurope.org/prospect/  

3. Feldheiser A, Aziz O, Baldini G, et al. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand. 2016;60(3):289-334. doi:10.1111/aas.12651 https://onlinelibrary.wiley.com/doi/10.1111/aas.12651  

4. Carella M, Beck F, Piette N, Denys S, Lecoq JP, Bonhomme VL. Comparison between supra-inguinal fascia iliaca and pericapsular nerve group blocks on postoperative pain and functional recovery after total hip arthroplasty: A noninferiority randomised clinical trial. Eur J Anaesthesiol. 2023 Sep 1;40(9):660-671. doi: 10.1097/EJA.0000000000001875. Epub 2023 Jun 30. PMID: 37395511. https://journals.lww.com/ejanaesthesiology/abstract/2023/09000/comparison_between_supra_inguinal_fascia_iliaca.8.aspx  

5. Carella M, Bicego A, Beck F, Malta C, Ardizzone L, Bonhomme VL, Vanhaudenhuyse A. Influence of virtual reality with or without hypnosis on patient-related experience and functional recovery in outpatient foot surgery with regional anesthesia: a randomized controlled trial. Reg Anesth Pain Med. 2025 Jun 22:rapm-2025-106678. doi: 10.1136/rapm-2025-106678. Epub ahead of print. PMID: 40545295. https://rapm.bmj.com/content/early/2025/06/20/rapm-2025-106678 

6. Carella M, Beck F, Piette N, Denys S, Kurth W, Lecoq JP, Bonhomme VL. Effect of suprainguinal fascia iliaca compartment block on postoperative opioid consumption and functional recovery in posterolateral-approached total hip arthroplasty: a single-blind randomized controlled trial. Reg Anesth Pain Med. 2022 Jun 15:rapm-2021-103427. doi: 10.1136/rapm-2021-103427. Epub ahead of print. PMID: 35705263. https://rapm.bmj.com/content/47/9/547.long  

7. Gadsden J, Warlick A. Regional anesthesia for the trauma patient: improving patient outcomes. Local Reg Anesth. 2015;8:45-55. Published 2015 Aug 12. doi:10.2147/LRA.S55322 https://www.dovepress.com/regional-anesthesia-for-the-trauma-patient-improving-patient-outcomes-peer-reviewed-fulltext-article-LRA  

8. O’Donnell BD, Iohom G. Regional anesthesia techniques for ambulatory orthopedic surgery. Curr Opin Anaesthesiol. 2008 Dec;21(6):723-8. doi: 10.1097/aco.0b013e328314b665. PMID: 19009687. https://journals.lww.com/co-anesthesiology/abstract/2008/12000/regional_anesthesia_techniques_for_ambulatory.7.aspx  

9. https://www.ucc.ie/en/anaesthesiology/staff-profile/gabriella-iohom-ucc/ 

10. Ahmed HM, Atterton BP, Crowe GG, et al. Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project. Regional Anesthesia & Pain Medicine 2022;47:301-308. https://rapm.bmj.com/content/47/5/301  

11. Bugada D, Ghisi D, Mariano ER. Continuous regional anesthesia: a review of perioperative outcome benefits. Minerva Anestesiol. 2017 Oct;83(10):1089-1100. doi: 10.23736/S0375-9393.17.12077-8. Epub 2017 Jun 12. PMID: 28607342. https://www.minervamedica.it/index2.t?show=R02Y2017N10A1089 

12. Bugada D, Bellini V, Fanelli A, et al. Future Perspectives of ERAS: A Narrative Review on the New Applications of an Established Approach. Surg Res Pract. 2016;2016:3561249. doi:10.1155/2016/3561249 https://onlinelibrary.wiley.com/doi/10.1155/2016/3561249  

13. Accurso, G., Rampulla, D., Cusenza, M. et al. A blended opioid-free anesthesia protocol and regional parietal blocks in laparoscopic abdominal surgery- a randomized controlled trial. Sci Rep 15, 14097 (2025). https://doi.org/10.1038/s41598-025-97116-x https://www.nature.com/articles/s41598-025-97116-x