Abstract
Blocking Brachial plexus has become increasingly preferred in upper limb and shoulder surgeries because it provides reliable surgical anaesthesia, prolonged postoperative analgesia, limb immobilization, and decreases the requirement for general anaesthesia. and its associated adverse effects. Ultrasound guidance permits for precise deployment of needles and effective deposition of local anaesthetics, rapid onset of block, improved patient satisfaction, and a lower risk of vascular injury. Opioids such as morphine, fentanyl, and buprenorphine have been explored as adjuvants to local anaesthetics to further enhance block characteristics. This meta-analysis examined the effectiveness and safety of incorporating morphine, fentanyl, or buprenorphine as adjuncts to brachial plexus anaesthesia in patients undergoing arthroscopic shoulder or other upper-limb procedures. A thorough and systematic search of the literature was carried out in databases such as PubMed, Google Scholar, Science Direct, and additional sources to identify randomized controlled trials that compared these opioid adjuvants with placebo or no supplementary agent. Outcomes assessed included onset time of sensory block, duration of postoperative analgesia, and incidence of complications. The Cochrane risk-of-bias approach was implemented for evaluating bias, and statistical investigation was executed with Review Manager 5.4 software. Thirty-five randomized controlled trials involving 2335 patients were included. Pooled analysis demonstrated a statistically significant improvement in analgesic duration with opioid adjuvants compared to control groups (P < 0.01; Z = 7.37; I² = 96%). Buprenorphine showed a greater impact on reducing onset time. Adverse effects were comparable across groups. Relying on the GRADE structure, the quality of evidence for prolonged analgesia was high. The co-administration of morphine, fentanyl, or buprenorphine to local anaesthetics in blocks of the brachial plexus substantially enhances sensory and motor block duration and additionally provides postoperative analgesia without increasing adverse effects, offering efficacy comparable to other regularly used adjuvants.
Keywords: Brachial Plexus Block, Buprenorphine, Fentanyl, Morphine, Opioid Adjuvants, Postoperative Analgesia.