Precision and pitfalls: evolving role of ultrasound-guided nerve blocks in Orthopedic perioperative pathway—a perspective

Ultrasound-guided regional anesthesia (UGRA) has become an integral part of enhanced recovery protocols in orthopedic surgery, advancing from landmark-based methods to image-guided precision. Yet its broad implementation and comprehensive integration into perioperative care remain challenging. This perspective article argues that while UGRA improves anatomical targeting, intraoperative stability, and postoperative recovery, it also introduces specific risks related to technique, judgment, and complications. A structured, evidence-informed framework is therefore needed to maximize its benefits while proactively mitigating these risks. By scrutinizing current evidence and clinical experience, this article presents a multi-level analysis spanning diverse surgical settings-from trauma to elective procedures-and explores emerging directions in technology, training, and outcomes research. In summary, we propose a "precision with prudence" approach that combines standardized protocols with individualized care. Strengthening multidisciplinary coordination and perioperative continuity can help transform UGRA from a procedural skill into a central element of patient-centered recovery, ultimately improving functional outcomes and long-term quality of life after orthopedic surgery.