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 blockade (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. The risk of bias was assessed.

Results: Nine clinical trials involving 487 patients were included. BPB resulted in significantly lower pain scores within 2 h postoperatively (MD -4.57, 95% CI -5.76 to 3.38; participants = 263; studies = 5; I2 = 0%; p < 0.00001) but not from 6 to 24 h. Opioid consumption (mg) was lower in the BPB group in the first 24 h (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 (OR 0.19, 95% CI 0.10-0.33; 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 the number of patients not requiring opioids from 24 to 48 h.

Conclusions: BPB provided superior pain control at 2 h 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 h or beyond 24 h, likely due to block wear-off. Despite this limitation, BPB still offered perioperative advantages over GA.