Table 3. Challenges and considerations in implementing regional anesthesia for cancer patients.

Category	Challenges	Considerations
Patient-related factors [37]	Comorbidities (e.g., cardiovascular disease, diabetes)	Pre-anesthetic assessment to identify risks and optimize patient condition.
	Coagulopathy and bleeding risks	Careful evaluation of coagulation status and potential need for blood products.
	Altered anatomy due to previous surgeries or radiation therapy	Use advanced imaging techniques (e.g., ultrasound guidance) for accurate needle placement.
	Psychological factors and patient preferences	Thorough preoperative counseling to address anxieties and set expectations about anesthesia options.
Tumor-related considerations [4]	Tumor location affecting regional anesthesia approach (e.g., spinal vs. epidural vs. nerve block)	Customized anesthesia plans based on tumor type, location, and extent.
	Potential for tumor seeding or spread due to invasive procedures	Minimize needle insertion through tumor-affected areas and consider non-invasive approaches when possible.
Technical challenges [38]	Difficulty in performing regional blocks due to anatomical changes (e.g., scar tissue, edema)	Training in advanced regional anesthesia techniques and equipment (e.g., nerve stimulators, continuous catheters).
	Need for precision in needle placement to avoid complications	Utilization of real-time imaging techniques like ultrasound to improve safety and accuracy.
	Equipment availability and technological limitations in certain settings	Ensuring access to and maintenance of necessary anesthesia equipment and technology, particularly in resource-limited settings.
Perioperative management [39]	Balancing analgesia with cancer patients’ need for clear mental status during the postoperative period	Selecting appropriate dosages and monitoring protocols to maintain patient comfort without excessive sedation.
	Interaction of regional anesthesia with concurrent chemotherapy or radiation therapy	Coordination with the oncology team to optimize the timing of anesthesia relative to other cancer treatments to minimize adverse interactions and optimize patient safety.