Efficacy of popliteal plexus block for opioid sparing and pain management after lower extremity surgery: a meta-analysis.

Background: Postoperative pain management often depends on opioids, despite the associated adverse effects. The popliteal plexus block (PPB) presents a promising technique to reduce opioid consumption in surgeries. Methods: This meta-analysis evaluates the effectiveness of PPB when added to other nerve blocks, as well as its comparative efficacy against other block techniques, in improving postoperative recovery. Randomized controlled trials (RCTs) investigating the effect of PPB in adults undergoing lower extremity surgery were included. The primary outcome was 24-hour opioid consumption; secondary outcomes included pain scores at 12 and 24 hours, and the incidence of postoperative nausea and vomiting (PONV). The pooled effect size was quantified using mean difference (MD), standardized MD (SMD), or relative risk (RR) with a 95% confidence interval (CI). Results: Quantitative synthesis was restricted to studies evaluating PPB as an add-on to another nerve block technique. Compared with the standalone comparator, PPB significantly reduced 24-hour opioid consumption (5 studies; SMD: -1.32; 95% CI: -2.29 to -0.34), pain scores at 12 hours (4 studies; MD: -1.32; 95% CI: -2.25 to -0.39) and 24 hours (4 studies; MD: -0.52; 95% CI: -1.02 to -0.02), and the incidence of PONV (3 studies; RR: 0.21; 95% CI: 0.08 to 0.55). Three additional single-trial head-to-head comparisons (vs. other blocks) were not pooled and are reported narratively. Conclusions: As an add-on, PPB reduces opioid consumption, pain scores, and PONV incidence. Head-to-head evidence against other blocks remains limited and inconsistent; further high-quality RCTs are warranted to clarify comparative efficacy and address heterogeneity.