Perioperative pain management has shifted from opioid-centered rescue analgesia toward multimodal, opioid-sparing strategies that support early rehabilitation. Intravenous patient-controlled analgesia remains useful, but it cannot fully prevent early breakthrough pain and is limited by opioid-related adverse effects. Regional anesthesia, including peripheral nerve and fascial plane blocks, provides procedure-specific analgesia with reduced systemic drug exposure. The wider adoption of ultrasound guidance, long-acting local anesthetic formulations, selected adjuvants, and continuous perineural infusion has expanded the role of regional techniques in enhanced recovery pathways. This review summarizes the rationale, technical advances, procedure-specific applications, and implementation challenges of regional anesthesia in modern perioperative analgesia. Emphasis is placed on sensory-motor balance, patient selection, geriatric and critically ill populations, nerve injury surveillance, prevention of local anesthetic systemic toxicity, and data-driven pain assessment. Standardized training, structured outcome monitoring, and information-supported decision-making are needed to translate regional anesthesia into consistent and safe perioperative outcomes.