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Perioperative Pain Management Using Local and Regional Analgesia for Cardiothoracic Surgeries, Mastectomy, and Abdominal Surgeries (New! published January 2026)
This practice guideline provides evidence-based recommendations for perioperative pain management in adults and children undergoing cardiothoracic, mastectomy, and abdominal surgery. It focuses on the use of local and regional analgesia — particularly fascial plane blocks — as key components of a multimodal analgesia strategy to reduce postoperative pain and opioid requirements during the first 24 hours after surgery.
Postoperative pain remains a significant and persistent challenge, with many surgical patients experiencing moderate to severe pain despite available therapies. Inadequate pain control is associated with delayed recovery, increased opioid exposure, and the risk of chronic postsurgical pain. This guideline addresses these concerns by offering procedure-specific recommendations for regional and local analgesia techniques tailored to surgical type, invasiveness, and patient age.
Strong evidence supports the use of fascial plane blocks to reduce pain and/or opioid use after open cardiothoracic, mastectomy, and abdominal surgeries in adults, as well as after open cardiothoracic procedures in children. When appropriately incorporated into multimodal analgesia regimens, these techniques improve early postoperative comfort, enhance patient satisfaction, and support safer, more effective recovery.
ASA has developed tools and resources that can help clinicians implement these recommendations in practice. Additional context and expert insights are available through related publications and educational resources. Together, these tools support consistent, evidence-based application of regional and local analgesia techniques across a wide range of surgical settings.
The Central Line podcast episode, 2026 Regional Analgesia Guidelines for Thoracic and Truncal Surgeries, featuring Dr. Edward Mariano, highlights the new acute pain guideline, exploring why it was developed, key recommendations, and how anesthesiologists can begin applying regional analgesia strategies in practice.
New course coming this summer:
Guidelines and Advisories: Regional Analgesia for Truncal Surgeries will guide learners through creating perioperative analgesia plans, selecting procedure‑specific regional analgesia techniques, and addressing barriers to implementing regional analgesia in clinical practice.
Last updated by: Department of Quality and Practice Guidelines
Date of last update: February 24, 2026
You do not have to make a payment at this time, but you can reach out to your practice/group leader to find out when they plan to pay your dues. Email or call the ASA Support team for assistance: (630) 912-2552 or info@asahq.org.
