Brachial Plexus Block vs General Anesthesia in Upper Extremity Surgery

Adana City Training and Research Hospital120 enrolled

Overview

This study compares two different anesthesia methods for upper arm and hand surgery: regional anesthesia (brachial plexus block) versus general anesthesia. Regional anesthesia numbs only the arm being operated on by injecting local anesthetic near the nerves, while the patient remains awake or lightly sedated. General anesthesia puts the patient completely asleep using medications given through a breathing tube. The main goals of this study are to compare: * How much pain patients experience after surgery * Patient satisfaction with their anesthesia * Side effects such as nausea, vomiting, or breathing problems * Time until patients are ready to go home * Overall safety of each method Participants in this study will be randomly assigned to receive either brachial plexus block or general anesthesia for their scheduled upper extremity surgery. The research team will monitor participants during surgery and follow their recovery for 24 hours after the operation. This research will help doctors and patients make better-informed decisions about which type of anesthesia may be best for upper extremity procedures.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

120

Conditions

Upper Extremity Surgery Regional Anesthesia

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * clusion Criteria: * Adults aged 18-65 years * ASA physical status I-II * Scheduled for elective upper-extremity orthopedic surgery * Able to provide informed consent * Able to understand and complete study questionnaires Exclusion Criteria: * Contraindications to regional anesthesia * Coagulopathy or bleeding disorders * Local infection at the block site * Patient refusal of regional anesthesia * Known allergy to local anesthetic agents * Chronic opioid use (daily use for \>3 months) * Psychiatric disorders preventing cooperation or consent * Pregnancy or breastfeeding * Severe respiratory disease (for general anesthesia group) * Pre-existing neurological deficit in the operative extremity * Emergency surgery * ASA physical status III or higher

Outcomes

Primary Outcomes

Preoperative Anxiety Score

Preoperative anxiety measured immediately prior to operating room entry using the State-Trait Anxiety Inventory-State (STAI-S) scale. STAI-S is a validated 20-item questionnaire assessing current state anxiety. Scores range from 20 to 80, with higher scores indicating greater anxiety levels.

Time frame: Immediately before operating room entry (preoperatively)

Secondary Outcomes

Postoperative Pain Score

Pain intensity measured using Visual Analog Scale (VAS) at multiple time points after surgery. VAS scores range from 0 to 10, where 0 indicates no pain and 10 indicates worst pain imaginable. Lower scores indicate better outcome.

Time frame: From end of surgery to 24 hours postoperatively

Opioid Consumption

Total opioid consumption measured as morphine equivalent dose (mg) during the postoperative period. All opioid medications administered were converted to morphine equivalents using standard conversion factors. Lower consumption indicates better outcome.

Time frame: From end of surgery to 24 hours postoperatively

Number of Participants with Postoperative Nausea and Vomiting (PONV)

Number of participants experiencing postoperative nausea and/or vomiting requiring antiemetic treatment during the postoperative period. PONV was defined as any episode of nausea or vomiting reported by the patient or requiring rescue antiemetic medication.

Time frame: First 24 hours postoperatively

PACU Length of Stay

Duration of stay in the Post-Anesthesia Care Unit (PACU) measured in minutes, from admission to discharge readiness based on standardized discharge criteria (Aldrete score ≥9). Shorter stay indicates better recovery.

Time frame: From PACU admission until discharge readiness (typically 0-4 hours postoperatively

Quality of Recovery (QoR-15) Score

Patient-reported quality of recovery assessed using the validated Quality of Recovery-15 (QoR-15) questionnaire. QoR-15 is a 15-item instrument measuring five dimensions of recovery: physical comfort, emotional state, psychological support, physical independence, and pain. Each item is scored 0-10, with total scores ranging from 0 to 150. Higher scores indicate better quality of recovery.

Time frame: 24 hours postoperatively

Patient Satisfaction Score

Overall patient satisfaction with anesthesia care measured using a numerical rating scale from 0 to 5, where 0 indicates completely dissatisfied and 5 indicates completely satisfied. Patients were asked to rate their overall satisfaction with the anesthesia experience.