Many operations can be performed under regional anaesthesia although in practice general anaesthesia is often administered following the block. Prior to undertaking any block, you must have obtained consent, have good anatomical knowledge of the proposed block, vascular access and perform the block under septic conditions. There is the potential for Local anaesthetic dose and toxicity and resuscitation drugs (including intralipid) should be available.

Some blocks can be performed using landmarks alone but the advent nerve stimulators and latterly ultrasound has transformed the delivery of regional anaesthesia, allowing accurate placement of local anaesthetic often with reduced doses.

Numerous blocks have been described but the major ones include interscalene and axillary brachial plexus blocks for the upper limb, erector spinae blocks for rib fractures and chest wall surgery, rectus sheath blocks for midline abdominal surgery and femoral nerve and adductor canal and popliteal/sciatic nerve block blocks for lower limb surgery.

Whilst providing excellent analgesia it is important to avoid serious complications and errors. Ensure that the block is inserted on the correct side (STOP BEFORE YOU BLOCK), avoid direct nerve damage and inadvertent intravenous injection. Patients need information on postoperative care, in particular that any blocked limb may be weak for several hours.