Introduction: The Plan A blocks framework was proposed in 2019 with the aim of promoting a small number of versatile, high-value regional anaesthetic techniques to build core competencies among all anaesthetists. Clinical practice, educational curricula and academic understanding have evolved since then. We aimed to provide a pragmatic and clinically focused narrative review on the current understanding of Plan A blocks and to explore their implementation and signpost future directions.
Methods: We conducted a focused literature search for articles of relevance to Plan A blocks. We also searched online resources, including websites of societies and institutions, for evidence relevant to our primary area of interest.
Results: Plan A blocks have influenced the Royal College of Anaesthetists' curriculum and inspired several international consensus projects defining core blocks for adult and paediatric practice. Delphi studies have supported the inclusion of interscalene brachial plexus, axillary brachial plexus, femoral and sciatic nerve blocks as key techniques. Despite wide dissemination, challenges hindering clinical practice change persist, including resource limitations; lack of confidence; and variable access to structured training. Emerging educational technologies such as simulation, artificial intelligence-assisted ultrasound interpretation and augmented reality offer promise, but remain limited by cost and fidelity.
Discussion: The Plan A blocks framework has become an established concept and is accepted widely as a pragmatic, scalable strategy. Although barriers remain to clinical practice change, ensuring widespread competence in Plan A blocks and implementation into clinical pathways should improve patient access to regional anaesthesia globally.
Keywords: continuing professional development; education; implementation; innovation; plan A blocks; regional anaesthesia.
What we did: We reviewed research papers and online teaching resources about “Plan A blocks”. Plan A blocks are a small set of nerve block techniques that doctors can use to help control pain during and after surgery. We looked at how these blocks are taught, how often they are used, and what new teaching tools might help doctors learn them better.
Why did we do it: Plan A blocks were introduced to help all anaesthetists learn a few important pain‐control techniques well. Since they were first suggested in 2019, training and medical knowledge have changed. We wanted to check: how well Plan A blocks are being used now; and what might help more doctors learn and use them in the future.
What we found: We found that Plan A blocks are now part of anaesthetic training in the UK and other countries. Experts agree that some key blocks (for the shoulder, arm and leg) are especially important to learn. Many doctors still find it hard to use these blocks because of not enough training time; lack of confidence; and limited equipment or teaching support. New tools like simulators, smart ultrasound and virtual or augmented reality may help training, but they are expensive and not widely available yet. Overall, Plan A blocks are now well accepted and seen as a useful way to improve pain care for patients. If more doctors are trained in them, more patients around the world could benefit from better pain relief after surgery.
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