BEYOND ANALGESIA: FASCIAL PLANE BLOCKS AS MODULATORS OF THE SURGICAL STRESS RESPONSE

C. Angeletti, I. Olivieri, G. Di Giuseppe, G. Varrassi | Department of Anesthesia, Intensive Care and Pain Medicine, Mazzini Hospital, Teramo, Italy

Background and Aims. Fascial plane blocks are increasingly used as part of multimodal analgesia in perioperative care. While traditionally seen only as pain-relief techniques, their ability to influence the systemic stress response to surgery is still not well understood. Surgical trauma triggers a complex neuroendocrine and inflammatory response, involving sympathetic activation, hypothalamic–pituitary–adrenal (HPA) axis activation, and cytokine release, all of which can affect postoperative recovery and organ function. To create a clinically relevant framework that views fascial plane blocks as modulators of the surgical stress response, beyond their role in pain relief.
Methods. We conducted a narrative, mechanism-based review that integrates current evidence on regional anesthesia, autonomic modulation, and perioperative stress physiology, with a focus on fascial plane techniques.
Results. By reducing nociceptive input at its source, fascial plane blocks may decrease central sensitization and limit activation of stress-related pathways. This could result in lower sympathetic output, better autonomic balance, and decreased neuroendocrine activation. Emerging evidence suggests potential downstream effects, including reduced catecholamine release, modulation of inflammatory responses, improved hemodynamic stability, and decreased opioid requirements. These mechanisms may help enhance recovery, reduce complication rates, and improve patient-centered outcomes. However, current data are heterogeneous and largely indirect, with few studies specifically evaluating systemic effects.
Conclusions. Fascial plane blocks should be viewed not only as pain management tools but also as potential modulators of the surgical stress response. Adopting a broader physiological perspective can facilitate their incorporation into strategies to improve perioperative resilience and recovery.