Is preoperative adrenoceptor blockade necessary in patients with paraganglioma?

Pheochromocytomas and paragangliomas, collectively known as paragangliomas (PGLs), are rare neuroendocrine tumors originating from chromaffin cells. Surgical resection is the treatment of choice with preoperative α-adrenoceptor blockade being consistently used prior to any surgical intervention; however, this approach has recently been challenged. This comprehensive systematic review of the literature was conducted across PubMed, EMBASE, and the Cochrane Library up to December 2025 to address the necessity and potential indications of α-adrenoceptor blockade in the pre-, peri- and postoperative phase of PGL management. Papers were categorized into guidelines/consensus, meta-analyses, and clinical studies. All international guidelines uniformly recommend preoperative α-adrenoceptor blockade for functional PGLs, albeit there is no substantial evidence to support abandoning this longstanding practice. Therefore, both for medicolegal considerations and alignment with current clinical practice, the recommendation for preoperative α-adrenoceptor blockade is still widely utilized. However, recent meta-analyses and patient cohort studies indicate no significant benefits in terms of mortality, intraoperative, or postoperative outcomes using such agents in selective patient populations. The paucity of randomized controlled trials and the recent progress in clinical practice and surgical/anesthetic techniques underscore the need for a re-evaluation of the routine use of α-adrenoceptor blockade during PGL surgical resections to resolve this issue.