Brachial Plexus Block Versus General Anesthesia for Upper-Extremity Orthopedic Surgery: Effect on Preoperative Anxiety and Recovery Outcomes – A Randomized Controlled Trial

Background: Preoperative anxiety is common in surgical patients and associated with adverse perioperative outcomes. While ultrasound-guided brachial plexus block (BPB) provides effective analgesia for upper-extremity surgery, its isolated effect on preoperative anxiety compared with general anesthesia (GA) remains underexplored. This randomized controlled trial compared BPB with GA for their effects on preoperative anxiety and postoperative recovery in adults undergoing elective upper-extremity orthopedic surgery. Methods: We conducted a prospective, randomized, parallel-group superiority trial at a tertiary academic hospital. Adults aged 18–65 years with ASA physical status I–II undergoing elective upper-extremity orthopedic procedures were randomized 1:1 to ultrasound-guided infraclavicular BPB or GA. All participants received standardized preoperative education and harmonized perioperative care. Primary endpoint was preoperative anxiety immediately prior to operating room entry measured using State-Trait Anxiety Inventory-State (STAI-S). Secondary endpoints included pain scores, opioid consumption, postoperative nausea and vomiting (PONV), post-anesthesia care unit (PACU) length of stay, quality of recovery-15 (QoR-15), and patient satisfaction. Results: 120 patients were randomized (60 per group) with 0% loss to follow-up. BPB reduced preoperative anxiety compared with GA (STAI-S: adjusted mean difference −3.03, 95% CI: −6.04 to −0.02, p=0.048). BPB also demonstrated superior outcomes in early pain reduction (adjusted MD −1.43, p<0.001), opioid consumption (mean ratio 0.52, p<0.001), PONV incidence (adjusted OR 0.36, p=0.025), PACU length of stay (median difference −18.3 min, p<0.001), QoR-15 scores (adjusted MD 9.92, p<0.001), and patient satisfaction (adjusted MD 0.37, p=0.004). Five patients (8%) in the BPB arm required conversion to GA. No serious adverse events occurred. Conclusions: Within a standardized perioperative pathway, brachial plexus block was associated with a statistically significant but clinically modest reduction in preoperative anxiety, accompanied by robust multidomain recovery advantages over general anesthesia. The clinical significance of the isolated anxiety reduction remains uncertain; however, the constellation of benefits across pain, opioid consumption, PONV, and quality of recovery supports an overall favorable treatment effect for regional anesthesia in upper-extremity orthopedic surgery. Trial Registration: ClinicalTrials.gov NCT07352839. Retrospectively registered on January 13, 2026.