Fascial Plane Blocks in Perioperative and Pain Medicine: From Mechanisms to Emerging Multitarget Interfascial Strategies.

PURPOSE OF REVIEW: Fascial plane blocks (FPBs) are increasingly used in perioperative and pain medicine, but their clinical role remains difficult to define because mechanisms, nomenclature, and evidence quality vary across techniques and indications. RECENT FINDINGS: Recent anatomical and clinical literature supports a shift away from viewing fascia as a passive conduit. Deep fascia is innervated, mechanically active, and organized into communicating compartments that may influence injectate spread and analgesia. Established techniques such as erector spinae plane, transversus abdominis plane, quadratus lumborum, pectoral plane, and serratus anterior plane blocks provide useful but indication-specific perioperative benefits. Comparative evidence is more nuanced when FPBs are tested against paravertebral or epidural techniques. Emerging posterior cervical and periscapular multitarget approaches are anatomically plausible but are supported only by a seven-patient uncontrolled series, technical or anatomical descriptions, and small retrospective uncontrolled studies; they should therefore be regarded as hypothesis-generating rather than practice-changing. Large-volume dosing and cumulative systemic local anesthetic exposure remain important safety considerations. FPBs should be used as anatomy-guided, indication-specific interventions rather than as a uniform class of interchangeable blocks. Emerging multitarget strategies are not yet established clinical recommendations. Future work should prioritize standardized nomenclature, dose discipline, comparative trials, and patient-centered outcomes.