Brachial Plexus Blockage versus General Anesthesia for Upper Extremity Surgery: A Systematic Review and Meta-analysis

Introduction: This meta-analysis investigated differences in rebound pain and opioid consumption when using brachial plexus block (BPB) versus general anesthesia (GA) for upper limb surgery. Methods: Four databases were searched. Odds ratios (OR), mean differences (MD), and standard mean differences (SMD) with 95% confidence intervals (CIs) were calculated. Outcomes included were pain, opioid consumption, adverse events, and discharge time. Risk of bias was assessed. Results: Nine Clinical Trials involving 487 patients were included. BPB resulted in significantly lower pain scores within 2 hours postoperatively (MD-4.57, 95%CI-5.76 to 3.38; participants=263; studies=5; I2=0%; p<0.00001) but not from 6-24 hours. Opioid consumption (mg) was lower in the BPB group in the first 24 hours (SMD-0.85, 95%CI-1.41 to -0.29; participants=188; studies=3; I2=67%; p<0.003). BPB was associated with fewer postoperative nausea/vomiting events (OR0.19, 95%CI0.10 to 0.33; participants=326; studies=6; I2=45%; p<0.00001) and shorter hospital stay (SMD-1.20, 95%CI-1.73 to -0.66; participants=213; studies=4; I2=69%; p<0.0001). There was no difference in number of patients not requiring opioids from 24-48 hours. Conclusions: BPB provided superior pain control at two hours postoperatively and was associated with reduced opioid use, fewer adverse events, and shorter discharge time. No significant differences in pain scores were observed at 6–24 hours or beyond 24 hours, likely due to block wear-off. Despite this limitation, BPB still offered perioperative advantages over GA.