Purpose of Review <p> Penile inversion vaginoplasty is a complex procedure performed as part of gender-affirming care. It is a highly complex procedure involving extensive genital deconstruction and reconfiguration. As a result, effective post-operative pain control is a central component of perioperative care in this patient population. This review aims to synthesize and consolidate the current evidence on regional anesthesia techniques for postoperative pain management in patients undergoing penile inversion vaginoplasty.</p> Recent Findings <p> Effective pain management is critical, as inadequate control has been associated with decreased patient satisfaction, prolonged hospital stays, increased opioid consumption, delayed ambulation, and higher overall healthcare costs. Pain management strategies emphasize multimodal analgesia, incorporating acetaminophen, nonsteroidal anti-inflammatory drugs, opioids (oral and intravenous), local anesthetic infiltration by surgeons, nerve blocks, and neuraxial anesthesia. Within Enhanced Recovery After Surgery (ERAS) protocols, regional anesthesia, including neuraxial techniques and peripheral nerve blocks, has gained prominence and popularity, with substantial evidence demonstrating a reduction in overall opioid consumption and opioid-related adverse effects across a wide range of surgical procedures.</p> Summary <p> Regional anesthesia is a key component of multimodal analgesia and ERAS pathways in penile inversion vaginoplasty. Consolidating current evidence may help clarify its role in optimizing postoperative pain control, reducing opioid exposure, and improving recovery and patient-centered outcomes in this population.</p>