Background and aim: Regional nerve block, as an anesthetic technique, can enhance postoperative recovery for patients. Postoperative cognitive dysfunction (POCD) remains a critical concern for patients undergoing elbow joint release surgery. This randomized controlled trial evaluated whether combining regional nerve block (RNB) with general anesthesia (GA) improves cognitive outcomes compared to GA alone. Methods: A single-center and single-blind (outcome assessors and analysts blinded) observation study. Seventy-four patients (ASA I–II, aged 18–65 years, BMI < 26 kg/m ² ) undergoing elbow joint release surgery were randomly assigned to either a control group (GA alone) or an observation group (ultrasound-guided brachial plexus block: 20 mL 0.375% ropivacaine + GA). Primary outcome was MMSE scores on pre-op D 1 (preoperative day 1), POD 1 (postoperative day 1), and POD 3 (postoperative day 3). Secondary outcomes included awakening time, extubation time, VAS scores at 1, 6, and 12 hours after extubation and hemodynamic parameters at different time points. Results: The MMSE scores in the observation group were significantly higher than those in the control group both on the POD 1 (23.06 ± 1.01 vs 20.50 ± 0.51, mean difference 2.56 [95% CI 2.18 to 2.93]; P < 0.001) and POD 3 (25.56 ± 0.51 vs 23.36 ± 0.49, mean difference 2.19 [95% CI 1.96 to 2.43]; P < 0.001). The postoperative awakening time (3.50 ± 0.56 vs 11.83 ± 1.00 min, mean difference −8.33 [95% CI −8.71 to −7.95]; P < 0.001) and extubation time (3.50 ± 0.56 vs 13.08 ± 0.84 min, mean difference −9.58 [95% CI −9.92 to −9.25]; P < 0.001) in the observation group were significantly shorter than those in the control group. Furthermore, Visual analogue scale (VAS) scores in the observation group were lower than those in the control group at 1 hour (1.28 ± 0.61 vs 4.92 ± 0.77, mean difference −3.64 [95% CI −3.97 to −3.31]; P < 0.001), 6 hours (1.36 ± 0.54 vs 5.67 ± 0.68, mean difference −4.31 [95% CI −4.59 to −4.02]; P < 0.001), and 12 hours post-extubation(3.44 ± 0.50 vs 7.67 ± 0.48, mean difference −4.22 [95% CI −4.45 to −3.99]; P < 0.001). Hemodynamic stability was superior in the observation group across perioperative phases. Conclusions: Combining RNB with GA preserves postoperative cognitive function, accelerates recovery, and enhances analgesia in elbow joint release surgery. These findings support RNB as an adjunct to GA to mitigate POCD.

Background/Objectives: Pain-induced vasoconstriction and thrombosis cause vascular insufficiency, a major etiology of early necrosis in replanted digits. While systemic intravenous analgesia (SIVA) carries significant side effects, continuous brachial plexus block (CBPB) provides analgesia with vasodilation. Amidst uncertainties regarding distal vascular recanalization and sympathetic denervation, whether CBPB’s hemodynamic effects translate into improved perfusion and outcomes in replanted digits remains unknown. This randomized controlled trial compared the effects of CBPB versus SIVA on digit perfusion, vascular insufficiency, and survival rates post-replantation. Methods: After screening 113 patients, 55 patients (71 digits) were ultimately randomized and analyzed: the CBPB group (n = 27, 36 digits) received 0.2% ropivacaine infusion at 5 mL/h; the SIVA group (n = 28, 35 digits) received intravenous parecoxib 20 mg twice daily with supplemental tramadol for visual analog scale (VAS) scores > 3. The primary outcome was digital skin temperature trajectory measured at 0, 12, 24, 36, and 48 h postoperatively. Secondary outcomes included Doppler-quantified combined volumetric flow rate of the radial and ulnar arteries (RA-UA VFR) at identical timepoints, VAS scores, vascular insufficiency incidence, and 7-day digit survival. Results: CBPB significantly enhanced perfusion in replanted digits at all postoperative timepoints, with digital skin temperature peaking at 48 h (32 ± 1.6 °C vs. 31 ± 1.1 °C; p < 0.001) and RA-UA VFR peaking at 24 h (4.0 ± 0.83 vs. 1.8 ± 0.51 mL/s; p < 0.001) versus SIVA. Concurrently, CBPB provided superior analgesia (VAS 0.52 ± 0.51 vs. 1.9 ± 1.0; p < 0.001) and significantly reduced 48-h vascular insufficiency incidence (8.3% vs. 29%; p = 0.028). No significant difference was observed in seven-day survival rates between groups (97% vs. 91%; p = 0.329). Conclusions: CBPB significantly enhanced perfusion in replanted digits and reduced the incidence of vascular insufficiency, despite not conferring additional survival benefits.

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