The Relationship Between BMI, Postoperative Pain Outcomes, and Patient Satisfaction in Patients Undergoing Infraclavicular Brachial Plexus Block

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Objective: Obesity may influence postoperative pain and patient-reported outcomes after regional anesthesia through mechanisms beyond technical block success.This study evaluated the association between body mass index (BMI) categories and perioperative outcomes following ultrasound-guided infraclavicular brachial plexus block for upper extremity surgery.Methods: This retrospective observational cohort included 83 adult patients (≥18 years) undergoing hand, forearm, or elbow surgery with ultrasound-guided infraclavicular brachial plexus block as the primary anesthetic technique.Patients were stratified by BMI as <25 kg/m² (n=19), 25-30 kg/m² (n=46), and ≥30 kg/m² (n=18).Postoperative pain intensity was assessed using the Visual Analog Scale (VAS; 0-10) at 0, 6, 12, and 24 hours.Secondary outcomes included rescue analgesia, opioid consumption, and patient-reported outcome measures (PROMs), including satisfaction at 1 week and 1 month and subsequent preference for regional anesthesia at 1 month.Results: Demographic characteristics were similar across BMI groups (p>0.05).Postoperative VAS scores differed by BMI at 0, 12, and 24 hours, with higher pain levels observed in the BMI ≥30 group, most pronounced at 24 hours (3.11±1.89),while 6-hour scores were comparable between groups.Rescue analgesic use and opioid consumption did not differ between groups.Patient satisfaction and 1-month subsequent preference for regional anesthesia were significantly lower in the BMI ≥30 group compared with BMI <25 and BMI 25-30 (p<0.001).Conclusion: Higher BMI was associated with worse postoperative pain trajectories and lower patient-reported satisfaction after ultrasound-guided infraclavicular brachial plexus block, despite similar rescue analgesic use and opioid consumption across BMI categories.These findings suggest that BMI stratification may be relevant for individualized perioperative analgesic planning and patient-centered outcome optimization.

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