Analgesic and Hemodynamic Effects of Preoperative Ultrasound-Guided Brachial Plexus Block in Radius Fracture Surgery: A Propensity-Matched Cohort Study

<i>Background and Objectives</i>: Optimal pain control after radius fracture surgery is critical for recovery and reducing opioid exposure. While brachial plexus block (BPB) offers analgesic benefits, its additive effect alongside general anesthesia remains underexplored. <i>Materials and Methods</i>: We conducted a retrospective cohort study of adults undergoing open reduction and internal fixation for radius fractures under general anesthesia between July 2020 and September 2025. Patients receiving preoperative ultrasound-guided BPB were matched 1:1 to those without BPB using propensity score matching. Pain scores, hemodynamic changes, and anesthesia-to-incision time were compared using paired <i>t</i>-tests or Wilcoxon signed-rank tests. Perioperative opioid consumption and breakthrough morphine use were analyzed using conditional logistic regression, Kaplan-Meier survival analysis, and stratified Cox regression. <i>Results</i>: Among 707 eligible patients, 205 who received BPB were matched to 205 controls. In the matched cohort (<i>n</i> = 410), BPB was associated with lower intraoperative fentanyl use [16.1% vs. 43.4%; odds ratio (OR) = 0.23; 95% confidence interval (CI): 0.13-0.40; <i>p</i> < 0.001], reduced rescue analgesic use in the postanesthesia care unit (10.2% vs. 53.2%; OR = 0.06; 95% CI: 0.03-0.16; <i>p</i> < 0.001), and decreased total opioid use (mean morphine milligram equivalents: 2.3 ± 3.4 vs. 6.7 ± 5.6; <i>p</i> < 0.001). Pain scores were lower (visual analogue scale: 2.9 ± 1.4 vs. 3.9 ± 1.9; <i>p</i> < 0.001). Breakthrough morphine use was delayed and less frequent in the BPB group (19.0% vs. 28.3%; hazard ratio = 0.47; 95% CI: 0.29-0.78; <i>p</i> = 0.003). BPB attenuated hemodynamic responses (mean arterial pressure area under curve: 707.2 ± 512.5 vs. 979.3 ± 636.5; <i>p</i> < 0.001). <i>Conclusions</i>: Preoperative BPB improves perioperative analgesia, lowers opioid use, and stabilizes hemodynamics in radius fracture surgery.