Ultrasound-guided regional anesthesia (UGRA) improves accuracy and safety in geriatric anesthesia with real-time visualization. It enables precise needle navigation and anesthetic administration, improving the success of blocks and reducing the volume of medication required. In elderly patients, it minimizes opiate analgesia, reduces neuroinflammation and reduces the incidence of delirium and cognitive dysfunction. Supports ERAS protocols for early mobilization and recovery. Challenges include training and resources. Future innovations include artificial intelligence, sustained-release anesthetics, and personalized protocols. It requires standardized training and multicenter studies.