PROSPECT guidance by operation

The latest procedure-specific pain recommendations from the PROSPECT group, with what each says about regional anaesthesia. All recommend regular paracetamol and an NSAID unless contraindicated. Tap a card to read the paper on PubMed.

• OrthopaedicsTotal knee arthroplastyPROSPECT · Lavand'homme 2022 Adductor canal block plus periarticular infiltration.
• OrthopaedicsTotal hip arthroplastyPROSPECT · Carella 2026 Suprainguinal fascia iliaca or PENG block; infiltration if not possible. Not QL or ESP.
• OrthopaedicsRotator cuff repairPROSPECT · Toma 2019 Interscalene, or suprascapular with or without axillary nerve block.
• OrthopaedicsTotal shoulder arthroplastyPROSPECT · Mrazek 2026 Single-shot interscalene; infiltration as the alternative.
• OrthopaedicsHallux valgus repairPROSPECT · Wust 2025 Ankle block; wound infiltration as the alternative.
• SpineLumbar laminectomyPROSPECT · Peene 2020 Wound infiltration or instillation by the surgeon.
• SpineComplex spine surgeryPROSPECT · Waelkens 2021 Epidural analgesia with local anaesthetic; limited evidence for ESP.
• BreastOncological breast surgeryPROSPECT · Desai 2026 Any single-shot block: ESP, Pecs I and II, serratus anterior, paravertebral or infiltration.
• ThoracicVideo-assisted thoracoscopic surgeryPROSPECT · Feray 2021 Paravertebral or ESP first; serratus anterior second.
• ThoracicOpen thoracotomyPROSPECT · Lemoine 2026 Thoracic epidural or paravertebral first; ESP, RISS or intercostal second.
• CardiacCardiac surgery via sternotomyPROSPECT · Maeßen 2023 Parasternal block or wound infiltration.
• General surgeryLaparoscopic cholecystectomyPROSPECT · Bourgeois 2024 Port-site infiltration first; ESP or TAP second-line.
• General surgeryLaparoscopic sleeve gastrectomyPROSPECT · Debel 2025 Bilateral TAP block and port-site infiltration.
• General surgeryAppendicectomyPROSPECT · Freys 2024 Open: TAP block. Laparoscopic: intraperitoneal local anaesthetic.
• ColorectalOpen colorectal surgeryPROSPECT · Uten 2024 Epidural; bilateral TAP or IV lidocaine if not possible.
• ColorectalLaparoscopic colorectal surgeryPROSPECT · Lirk 2024 Wound infiltration.
• ColorectalHaemorrhoid surgeryPROSPECT · Bikfalvi 2023 Bilateral pudendal nerve block.
• HepatobiliaryOpen liver resectionPROSPECT · Dieu 2021 Thoracic epidural or bilateral subcostal TAP.
• ObstetricsElective caesarean sectionPROSPECT · Crowe 2026 Intrathecal morphine or diamorphine; fascial plane block or infiltration if not given.
• GynaecologyLaparoscopic hysterectomyPROSPECT · Lirk 2019 No block recommended; evidence for TAP inconsistent.
• NeurosurgeryCraniotomyPROSPECT · Mestdagh 2023 Scalp nerve block or incision-site infiltration.
• ENTTonsillectomyPROSPECT · Aldamluji 2020 Systemic analgesia; infiltration evidence inconsistent.
• PaediatricsCleft palate surgery (children)PROSPECT · Suleiman 2024 Suprazygomatic maxillary nerve block, or palatal block.