pfblocker is only as good as your lists. I have a bunch, but they do not block everything. Most update once or twice a month. The add blocker ones seem to work for most ads other than embedded video ads. Like on YouTube. They use to get blocked, but something has stopped it from working. Maybe my YouTube lists are not as complete as they use to be.
As for region/IP blocking. I have most of the world blocked. The only real issue I ran into was AWS servers in Ireland getting blocked for Plex. Made it so Plex apps could not remote connect to my plex server. Only fix was unblocking Ireland. IP's kept changing too many times to make whitelisting work.