Plan A blocks in regional anaesthesia: a narrative review

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.