Nerve blocks are a cornerstone of regional anesthesia, offering pain control, reduced reliance on systemic analgesics, and faster recovery times. While traditionally administered by anesthesiologists, there are specific contexts in which surgeons perform nerve blocks. This practice depends on the surgeon’s training, the clinical setting, and patient safety considerations.
A nerve block involves the injection of local anesthetic near a nerve or nerve plexus to temporarily inhibit pain signals. Commonly used for surgical anesthesia and postoperative pain management, nerve blocks can target various regions, including the brachial plexus, femoral nerve, and sciatic nerve. Ultrasound guidance or nerve stimulation often enhances precision 1,2.
Surgeons, particularly those specializing in orthopedic, plastic, or trauma surgery, may acquire the skills to perform nerve blocks during residency or through targeted training programs. The American Society of Regional Anesthesia and Pain Medicine (ASRA) and similar organizations worldwide offer educational resources and certifications for physicians interested in regional anesthesia.
In settings where anesthesiologists may not be readily available, such as rural hospitals or battlefield medicine, surgeons performing nerve blocks can improve patient outcomes. However, the ability to perform nerve blocks safely and effectively depends on adequate training and hands-on experience 3,4.
There are benefits to surgeons performing nerve blocks instead of anesthesiologists. Surgeons trained in nerve blocks can streamline perioperative workflows by reducing the dependency on anesthesiology teams. Relatedly, the surgeon’s involvement in both the procedural and pain management aspects of perioperative care fosters a holistic, efficient approach to patient care 5.
Although the integration of nerve blocks into a surgeon’s practice has benefits, several challenges must be addressed. Administering nerve blocks requires anatomical expertise, technical skill, and familiarity with potential complications, such as nerve damage, hematoma, or systemic local anesthetic toxicity. In light of this, incorporating nerve blocks into a surgeon’s duties may extend operating times or detract from surgical focus 6.
Studies evaluating surgeon-performed nerve blocks generally report favorable outcomes, particularly in settings where surgeons receive comprehensive training. For instance, orthopedic surgeons performing peripheral nerve blocks have demonstrated comparable efficacy and safety to anesthesiologists in select cases. However, widespread adoption requires standardized training protocols and quality assurance measures to be assessed in depth in the future 5,7,8.
The optimal model for nerve block administration may involve a collaboration between surgeons and anesthesiologists. In this scenario, anesthesiologists could handle complex cases, while trained surgeons could perform straightforward blocks to ensure high-quality care without overburdening either specialty 9,10.
Provided they have received appropriate training and are operating within the bounds of their scope of practice, surgeons can effectively perform nerve blocks. While there are potential benefits in efficiency and patient care, the adoption of this model should always emphasize safety, collaboration, and adherence to professional guidelines. Future research and standardization of training will further clarify the role of surgeons in administering nerve blocks.
References
1. Nerve Blocks For Surgery. Yale Medicine https://www.yalemedicine.org/conditions/nerve-blocks-for-surgery.
2. Nerve block. Cleveland Clinic https://my.clevelandclinic.org/health/treatments/12090-nerve-blocks.
3. CME-CPD. ASRA Pain Medicine https://www.asra.com/events-education/courses/ccra/cme-cpd.
4. ASRA Pain Medicine Home. ASRA Pain Medicine https://www.asra.com.
5. Drapeau-Zgoralski, V. et al. Surgeon-Performed Intraoperative Peripheral Nerve Blocks and Periarticular Infiltration During Total Hip and Knee Arthroplasty: A Critical Analysis Review. JBJS Rev 10, (2022). DOI: 10.2106/JBJS.RVW.22.00105
6. Wiederhold, B. D., Garmon, E. H., Peterson, E., Stevens, J. B. & O’Rourke, M. C. Nerve Block Anesthesia. in StatPearls (StatPearls Publishing, Treasure Island (FL), 2025).
7. Joiner, E. F. et al. Surgeon-Delivered Nerve Block for Reduction of Perioperative Pain and Opioid Use After Lumbosacral Spine Surgery. JAMA Network Open 5, e2248439 (2022). DOI: 10.1001/jamanetworkopen.2022.48439
8. Kitcharanant, N. et al. Surgeon-performed pericapsular nerve group (PENG) block for total hip arthroplasty using the direct anterior approach: a cadaveric study. Reg Anesth Pain Med 47, 359–363 (2022). DOI: 10.1136/rapm-2022-103482
9. Doerr, P. & Chidgey, B. Should Surgeons or Anesthesiologists Manage Perioperative Pain Protocols? AMA Journal of Ethics 22, 319–324 (2020). DOI: 10.1001/amajethics.2020.319
10. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 116, 248–273 (2012).