Find a block by operation

Pick an area, or type an operation, to see the blocks that suit it. Where a procedure-specific guideline exists, it is linked. The rest follow the nerve supply and common practice. Always combine a block with regular simple analgesia, and use your own judgement.

Shoulder and arm

Arthroscopic shoulder surgery and rotator cuff repair

First choiceInterscalene brachial plexus block
Also considerSuperior trunk block Suprascapular nerve block Axillary nerve block

Interscalene, or suprascapular block with or without an axillary nerve block. Use a phrenic-sparing option if respiratory reserve is poor.

Guideline: PROSPECT, rotator cuff repair (Toma 2019)
Shoulder replacement

First choiceInterscalene brachial plexus block
Also considerSuperior trunk block Suprascapular nerve block

Single-shot interscalene with a long-acting local anaesthetic. Local infiltration if a block is not possible.

Guideline: PROSPECT, total shoulder arthroplasty (Mrazek 2026)
Proximal humerus fracture

First choiceInterscalene brachial plexus block
Also considerSuperior trunk block Supraclavicular brachial plexus block

The shoulder and upper arm are supplied from C5–C6, so a high brachial plexus block suits.

No procedure-specific guideline: based on the nerve supply
Clavicle fracture fixation

First choiceInterscalene brachial plexus block
Also considerSuperior trunk block

Add a superficial cervical plexus block for the skin over the medial clavicle.

No procedure-specific guideline: based on the nerve supply
Elbow surgery

First choiceSupraclavicular brachial plexus block Infraclavicular brachial plexus block
Also considerCostoclavicular brachial plexus block Axillary brachial plexus block

Any block of the plexus below the clavicle covers the elbow. Add the intercostobrachial nerve for a high tourniquet.

No procedure-specific guideline: based on the nerve supply
Forearm and wrist surgery, including distal radius fracture

First choiceSupraclavicular brachial plexus block Infraclavicular brachial plexus block Axillary brachial plexus block
Also considerCostoclavicular brachial plexus block Forearm blocks Mid-humeral block

Forearm blocks are useful to rescue a patchy block.

No procedure-specific guideline: based on the nerve supply
Hand surgery

First choiceAxillary brachial plexus block
Also considerWrist block Forearm blocks Infraclavicular brachial plexus block

Wrist or forearm blocks suit short procedures without an upper-arm tourniquet.

No procedure-specific guideline: based on the nerve supply
Arteriovenous fistula formation

First choiceAxillary brachial plexus block Supraclavicular brachial plexus block
Also considerInfraclavicular brachial plexus block Intercostobrachial nerve block Medial cutaneous nerve of the arm block Medial cutaneous nerve of the forearm block Lateral cutaneous nerve of the forearm block

Add the intercostobrachial and medial cutaneous nerve of the arm for upper-arm fistulae, and the forearm cutaneous nerves for forearm fistula procedures.

No procedure-specific guideline: based on the nerve supply

Hip and leg

Hip fracture

First choiceSuprainguinal fascia iliaca block Femoral nerve block
Also considerInfrainguinal fascia iliaca block PENG block

Give a nerve block on admission and again at the time of surgery.

Guideline: Association of Anaesthetists hip fracture guideline (Griffiths 2021)
Total hip replacement

First choiceSuprainguinal fascia iliaca block PENG block
Also considerSpinal anaesthesia

Quadratus lumborum and lumbar erector spinae blocks are not recommended. Local infiltration is an alternative.

Guideline: PROSPECT, total hip arthroplasty (Carella 2026)
Total knee replacement

First choiceAdductor canal block
Also considerFemoral triangle block IPACK block Genicular nerve block Spinal anaesthesia

Single-shot adductor canal block plus periarticular local infiltration by the surgeon.

Guideline: PROSPECT, total knee arthroplasty (Lavand'homme 2022)
ACL reconstruction and knee arthroscopy

First choiceAdductor canal block
Also considerFemoral triangle block IPACK block

Motor-sparing blocks help early walking. Add IPACK for the back of the knee.

No procedure-specific guideline: based on the nerve supply
Femoral shaft fracture

First choiceFemoral nerve block
Also considerSuprainguinal fascia iliaca block Infrainguinal fascia iliaca block

Quick analgesia in the emergency department and before positioning for spinal anaesthesia.

No procedure-specific guideline: based on the nerve supply
Below-knee amputation

First choicePopliteal sciatic nerve block Adductor canal block
Also considerSubgluteal sciatic nerve block Femoral nerve block Spinal anaesthesia

Sciatic plus saphenous (adductor canal) blocks. Use a perineural catheter for longer analgesia.

No procedure-specific guideline: based on the nerve supply
Ankle fracture and ankle surgery

First choicePopliteal sciatic nerve block
Also considerAdductor canal block CAPS block Spinal anaesthesia

Add a saphenous (adductor canal) block for the medial ankle.

No procedure-specific guideline: based on the nerve supply
Forefoot surgery and bunion repair

First choiceAnkle block
Also considerPopliteal sciatic nerve block

Ankle block first. Wound infiltration is the alternative.

Guideline: PROSPECT, hallux valgus repair (Wust 2025)
Skin graft from the lateral thigh

First choiceLateral femoral cutaneous nerve block
Also considerSuprainguinal fascia iliaca block

The lateral cutaneous nerve of the thigh supplies the usual donor site.

No procedure-specific guideline: based on the nerve supply

Chest and breast

Breast cancer surgery

First choicePectoserratus plane block Erector spinae plane block Thoracic paravertebral block
Also considerInterpectoral plane block Serratus anterior plane block

Single-shot blocks are recommended and are considered equivalent to each other.

Guideline: PROSPECT, oncological breast surgery (Desai 2026)
Video-assisted thoracoscopic surgery (VATS)

First choiceThoracic paravertebral block Erector spinae plane block
Also considerSerratus anterior plane block

Serratus anterior plane block is the second choice.

Guideline: PROSPECT, VATS (Feray 2021)
Thoracotomy

First choiceThoracic epidural Thoracic paravertebral block
Also considerErector spinae plane block Rhomboid intercostal and sub-serratus block

Epidural or paravertebral first. Use other blocks only if neither is possible.

Guideline: PROSPECT, open thoracotomy (Lemoine 2026)
Rib fractures

First choiceErector spinae plane block Serratus anterior plane block
Also considerThoracic paravertebral block Thoracic epidural

Catheter techniques give continuous analgesia. Choose by the site of the fractures.

No procedure-specific guideline: based on the nerve supply
Cardiac surgery via sternotomy

First choiceSuperficial parasternal intercostal plane block
Also considerDeep parasternal intercostal plane block

Parasternal block or surgical site infiltration is recommended.

Guideline: PROSPECT, cardiac surgery via sternotomy (Maeßen 2023)

Abdomen

Laparoscopic cholecystectomy

Second lineErector spinae plane block Subcostal TAP block

Port-site infiltration first. Erector spinae or TAP blocks are second-line, for patients at high risk of pain.

Guideline: PROSPECT, laparoscopic cholecystectomy (Bourgeois 2024)
Laparoscopic sleeve gastrectomy

First choiceTransversus abdominis plane block
Also considerSubcostal TAP block

Bilateral TAP blocks plus port-site infiltration.

Guideline: PROSPECT, laparoscopic sleeve gastrectomy (Debel 2025)
Open colorectal surgery

First choiceThoracic epidural
Also considerTransversus abdominis plane block Rectus sheath block

Epidural first. Bilateral TAP block if an epidural is not possible.

Guideline: PROSPECT, open colorectal surgery (Uten 2024)
Open liver resection

First choiceThoracic epidural Subcostal TAP block

Thoracic epidural or bilateral oblique subcostal TAP blocks.

Guideline: PROSPECT, open liver resection (Dieu 2021)
Midline laparotomy and umbilical hernia

First choiceRectus sheath block
Also considerThoracic epidural Deep rectus sheath block

Bilateral rectus sheath blocks cover a midline incision. Catheters extend the effect.

No procedure-specific guideline: based on the nerve supply
Inguinal hernia repair

First choiceIlioinguinal and iliohypogastric nerve block
Also considerTransversus abdominis plane block Transversalis fascia plane block Quadratus lumborum blocks

Ilioinguinal and iliohypogastric block, or infiltration by the surgeon.

No procedure-specific guideline: based on the nerve supply
Nephrectomy and open renal surgery

First choiceQuadratus lumborum blocks Thoracic paravertebral block
Also considerErector spinae plane block Thoracic epidural

Flank incisions need T10–L1 cover.

No procedure-specific guideline: based on the nerve supply

Obstetrics, neuraxial and children

Caesarean section

First choiceSpinal anaesthesia Combined spinal-epidural
Also considerTransversus abdominis plane block Quadratus lumborum blocks

Intrathecal morphine first. If no neuraxial opioid is given, use a fascial plane block or wound infiltration.

Guideline: PROSPECT, elective caesarean section (Crowe 2026)
Labour analgesia

First choiceLumbar epidural
Also considerCombined spinal-epidural

Combined spinal-epidural gives a faster onset.

No procedure-specific guideline: based on the nerve supply
Children's lower abdominal and genital surgery

First choiceCaudal epidural block
Also considerIlioinguinal and iliohypogastric nerve block

Single-shot caudal block under general anaesthesia.

No procedure-specific guideline: based on the nerve supply

Find a block by operation

Shoulder and arm

Arthroscopic shoulder surgery and rotator cuff repair

Shoulder replacement

Proximal humerus fracture

Clavicle fracture fixation

Elbow surgery

Forearm and wrist surgery, including distal radius fracture

Hand surgery

Arteriovenous fistula formation

Hip and leg

Hip fracture

Total hip replacement

Total knee replacement

ACL reconstruction and knee arthroscopy

Femoral shaft fracture

Below-knee amputation

Ankle fracture and ankle surgery

Forefoot surgery and bunion repair

Skin graft from the lateral thigh

Chest and breast

Breast cancer surgery

Video-assisted thoracoscopic surgery (VATS)

Thoracotomy

Rib fractures

Cardiac surgery via sternotomy

Abdomen

Laparoscopic cholecystectomy

Laparoscopic sleeve gastrectomy

Open colorectal surgery

Open liver resection

Midline laparotomy and umbilical hernia

Inguinal hernia repair

Nephrectomy and open renal surgery

Obstetrics, neuraxial and children

Caesarean section

Labour analgesia

Children's lower abdominal and genital surgery