Foot and ankle surgery is often associated with significant postoperative pain that may delay mobilization and recovery. For this reason, effective perioperative analgesia is essential to improve outcomes, minimize opioid use, and enable safe early discharge when appropriate. This review provides an updated overview of regional anesthesia techniques for foot and ankle surgery, highlighting anatomical considerations, ultrasound guidance, and patient-tailored block selection. Different techniques will be specifically addressed over neuraxial and nerve blocks, such as the Mayo block and intravenous regional anesthesia (Bier block), as well as the emerging WALANT approach for selected cases. Ultrasound guidance has become a gold-standard, enhancing precision and safety compared to landmark-based methods. Multimodal analgesia combining regional blocks with non-opioid medications and adjuvants like intravenous dexamethasone further optimizes pain control while limiting opioid requirements. In ambulatory settings, motor-sparing techniques and short-acting spinal agents are emphasized to support rapid recovery and same-day discharge. By integrating anatomical knowledge with ultrasound and multimodal strategies, perioperative pain management for foot and ankle surgery can be tailored to balance effective analgesia with early mobilization and patient safety.

Shoulder surgery has radically evolved within the last 70 years, from a marginal orthopedic sub-specialty to an area of great research and advancement; consequently, anesthetic techniques have undergone important development. In fact, a wide variety of anesthetic strategies have emerged, to provide anesthesia and post-operative analgesia: general anesthesia (GA), regional anesthesia (RA), or combined GA and RA. A literature review on online databases was carried out about the different anesthetic approaches for shoulder surgery and their evolution through the years, taking in consideration papers from 1929 to 2021. A comprehensive preoperative assessment of patients undergoing shoulder surgery allows to identify and modify potential risk factors and complications of general anesthesia. Moreover, the use of ultrasound-guided regional blocks could improve the effectiveness of these techniques and bring better postoperative outcomes. Anesthetic management for shoulder surgery has progressed drastically during the last century. More studies are needed to finally standardize anesthetic techniques for specific procedure.

Article: A randomized clinical trial comparing different combination of peripheral nerve blocks for intraoperative analgesia in patients on antithrombotic drugs undergoing hip fracture surgery: pericapsular nerve group (PENG) block versus femoral and obturator nerve block - Minerva Anestesiologica 2024 Dec 10 - Minerva Medica - Journals

Hip fractures in elderly patients on anticoagulants pose anesthetic challenges when neuraxial anesthesia is contraindicated. We report four cases of pertrochanteric fractures in patients receiving Rivaroxaban, managed with a supra-inguinal fascia iliaca (SIFI) block and posterior pericapsular infiltration, consistent with 2024 European Society of Regional Anestesia (ESRA) guidelines favoring superficial blocks. Adequate analgesia was achieved within 20 minutes, enabling surgery under mild sedation with stable hemodynamics. No opioids or postoperative complications were observed. This combined regional approach effectively covers anterior and posterior hip innervation and may offer a safe alternative for high-risk anticoagulated patients. Further studies are warranted to validate these findings.