November 29, 2025
Background: Chronic postsurgical pain (CPSP) is a common adverse outcome following surgical procedures. Despite ongoing research, the risk factors and effective strategies for preventing CPSP remain uncertain. Regional anesthesia is a potentially beneficial, but still debated, intervention for reducing the risk of CPSP.
Review: This review examines the mechanistic basis of regional anesthesia and critically evaluates the current evidence regarding its effectiveness in preventing CPSP. The incidence and severity of CPSP are associated with nerve injury, neuroplastic changes, and immunological responses. Although multiple mechanisms have been identified, translational research remains limited and findings are often inconsistent. Various regional anesthetic techniques have been investigated, including wound infiltration, peripheral nerve blocks, fascial plane blocks, thoracic paravertebral blocks, and epidural anesthesia. Current evidence suggests that epidural anesthesia may reduce the risk of CPSP after thoracotomy, wound infiltration may be beneficial following major breast surgery and cesarean delivery, and serratus anterior plane block or pectoralis/interpectoral plane blocks may improve outcomes after breast surgery.
Conclusions: Regional anesthesia may help reduce the risk of chronic postsurgical pain in selected clinical settings. However, the available evidence remains limited, and the multifactorial nature of CPSP presents significant challenges. Further high-quality research is needed to clarify the role of different regional anesthesia techniques in preventing CPSP.
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