Purpose of Review <p>Regional anesthesia (RA) provides effective analgesia and reduces systemic opioid requirements, but emerging evidence suggests it also alters local microvascular physiology. This review synthesizes mechanistic and clinical data describing how RA modulates the microcirculation — the capillary and arteriolar network responsible for tissue perfusion and oxygen delivery.</p> Recent Findings <p>Human and animal studies using laser Doppler flowmetry, transcutaneous oximetry, and near-infrared spectroscopy demonstrate consistent increases in cutaneous and subdermal perfusion following peripheral and plexus blocks. Sympathetic blockade reduces α-adrenergic vasoconstriction, while local anesthetics may enhance endothelial nitric oxide release and attenuate inflammatory responses. In ischemic limbs, continuous sciatic blockade increased transcutaneous oxygen pressure by approximately 70% within 48 h. These microcirculatory gains are attenuated in smokers and patients with vascular disease, highlighting the role of baseline tone and endothelial integrity.</p> Summary <p>Beyond analgesia, RA exerts measurable microvascular effects that improve tissue oxygenation and may facilitate wound healing, flap viability, and ischemia-reperfusion tolerance. Current evidence remains heterogeneous and largely observational, but collectively supports a biologically plausible mechanism linking neural blockade to vascular health. Standardized perfusion metrics and outcome-linked trials are needed to define the therapeutic potential of RA as a modulator of perioperative microcirculation.</p>